| NPI | 1508919309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORECE GAYE NORRIS Medical Doctor 813-876-7073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME0038623) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |