| NPI | 1598136343 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKINA WILSON Chief Operating Officer 410-591-4273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: DC MD039929) |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2025-04-03 |