| NPI | 1093331639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY HALSEY Administrator 443-553-0057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2020-06-19 |