| NPI | 1275235103 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE COSTLEY Credentialing Specialist 443-839-6928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2024-12-03 |