| NPI | 1114318094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN WILSON BROUSSARD Vice President 443-838-3141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: MD Lic # U01120) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |