| NPI | 1972230639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUNIRATU FABODE Owner 240-461-9005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2022-08-03 |