| NPI | 1346835410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DREW FULLER Owner 443-622-4317 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine |
| Additional Taxonomies | 207RA0401X Internal Medicine, Addiction Medicine |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-08 |