Facts
- Status
- A
- Credential
- Ph.D.
- Type
- Individual
- Enumeration date
- 2007-06-29
- Last updated
- 2013-12-18
Specialties
Licenses
- License FL
- AY1290
- License NY
- 000377-1
Location
- Practice location
- 205 WORTH AVE, SUITE 201
- City
- PALM BEACH FL
- Postal code
- 334804606
- Phone
- 561-315-6378
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.