| NPI | 1487638219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBYN GANN Practice Manager 352-331-3353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME82864) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME76862) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2014-01-13 |