| NPI | 1104227628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY C LU Credentialing Coordinator 904-332-7431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL ME54094) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2014-09-29 |