| NPI | 1346520699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA ST ONGE Credentialing Manager 301-348-8580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101243278) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2024-05-20 |