| NPI | 1073309324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKINA WILSON Chief Operating Officer 410-591-4273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-04-15 |