| NPI | 1396261087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS J TRENTLY CFO 443-738-0281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2021-02-03 |