| NPI | 1770196511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEONARD MUGO Director 410-900-4619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2020-08-30 |
| Last Update Date | 2024-09-20 |