| NPI | 1366112385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANESE SANDY Provider 240-508-3363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 261QM0801X | |
| Enumeration Date | 2021-09-20 |
| Last Update Date | 2022-03-18 |