Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 1981
NPI: 1639133572
Practice Locations (2)
601 E DIXIE AVE, SUITE 301
LEESBURG, FL 347487302
601 E DIXIE AVE, SUITE 301
LEESBURG, FL 347487302
3527971001
Source: CMS National Downloadable File, September 2026.