| NPI | 1447829163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD PUCCIO President 703-858-6044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2021-06-18 |