| NPI | 1952853061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLOS FAGBENRO Owner 571-594-9110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169586) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2016-10-25 |