Individual
MR. EFETOBORE OMADEVUAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 PINEKNOT CT, GWYNN OAK, MD 21207-5585
(443) 739-1209
Mailing address
6628 RIDGEBORNE DR, ROSEDALE, MD 21237-3871
(443) 739-1209
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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