| NPI | 1164956439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCAS JACOB ROSENBLATT Principal 843-732-2207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: SC 93033) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: SC 11111) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-05-05 |