Graduated: 1982
NPI: 1619049111
Practice Locations (4)
1525 NW 62ND ST
FORT LAUDERDALE, FL 333091831
PO BOX, SUITE 917484
ORLANDO, FL 328917484
P O BOX, SUITE 452317
SUNRISE, FL 333452317
PO BOX
ATLANTA, GA 30374
Source: CMS National Downloadable File, September 2026.