| NPI | 1346608171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITUL DAVE Director 443-804-4628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2016-02-08 |