| NPI | 1902862154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KONSTANTIN KHLUDENEV Managing Partner 301-869-9776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD H0046438) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R129771) |
| 207R00000X Internal Medicine (Licence: MD D0059013) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-10-14 |