Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 21953 | MD |
NPI | 1376176859 |
---|---|
Provider Name | Benigno Abuesa Santos Jr |
First Address | Wheaton, MD 20902-2001 |
Second Address | Wheaton, MD 20902-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2020 |
Last Update Date | 13/02/2020 |