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Individual

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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
2401 W BELVEDERE AVENUE, BALTIMORE, MD 21215
(410) 601-7639
Mailing address
2401 W BELVEDERE AVENUE, BALTIMORE, MD 21215

Taxonomy

Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary

Other

Enumeration date
05/29/2025
Last updated
03/26/2026
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