NPI | 1114628278 |
---|---|
Entity Type | Organization |
Authorized Contact | IGOR KUPERMAN Member 410-702-3650 |
Organization Subpart ? | No |
Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
Additional Taxonomies | 305R00000X Preferred Provider Organization |
Enumeration Date | 2023-03-15 |
Last Update Date | 2023-03-15 |