| NPI | 1912330192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKINA WILSON Chief Operating Officer 410-591-4273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2024-03-19 |