| NPI | 1760907166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | UBONG JACKSON UDOYEN Md 803-269-7381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2018-05-22 |