Registry details
Type
Individual
Primary specialty
Psychiatry & Neurology, Neurology
Enumerated
Sep 22, 2011
License(s)
287407 (NY), 01083376A (IN), 0101268592 (VA), 72756-20 (WI), MT200484 (PA), 25MA10747300 (NJ), 2020-00091 (NC), 60058 (AZ), 53636 (KY), 85082 (GA), 01083376A (IN), ME143500 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 198054 | Atlanta, GA 30384-8054 | |
| LOCATION | 8900 N KENDALL DR | Miami, FL 33176-2118 | 786-596-3876 |
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