{
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"FirstLineMailingAddress": "231 BRIGHTON PARK WAY",
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"FirstLinePracticeLocationAddress": "6140A UNIVERSITY DR NW",
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"EnumerationDate": "02/17/2025",
"LastUpdateDate": "02/17/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARBUARY",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}