| NPI | 1487284816 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JON KOGAN Delegated Official 443-253-5533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2020-06-17 |