| NPI | 1386815322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE MARIANO Practice Manager 410-601-9258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MD D000150) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |