| NPI | 1962616813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK KELLY Practice Administrator 703-765-6093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: VA 0101041481) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-08-22 |