| NPI | 1649065574 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY TAMA Lpn 301-323-8520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2025-04-11 |