Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | S03688 | MD |
NPI | 1437600137 |
---|---|
Provider Name | William Jay Brady |
First Address | Columbia, MD 21044-4817 |
Second Address | Baltimore, MD 21213-1257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 18/10/2016 |