Individual
CHARITE OCTAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3390 NW 30TH ST APT 10, LAUDERDALE LAKES, FL 33311-1136
(772) 882-2275
Mailing address
3390 NW 30TH ST APT 10, LAUDERDALE LAKES, FL 33311-1136
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/20/2017
Last updated
04/20/2017
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