Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R194244 | MD |
NPI | 1003291949 |
---|---|
Provider Name | Andrew Brave |
First Address | Baltimore, MD 21215-5216 |
Second Address | Baltimore, MD 21215-5216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2015 |
Last Update Date | 20/03/2017 |