Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 22499 | MD |
NPI | 1003077660 |
---|---|
Provider Name | Dante Lemar Gorham |
First Address | Adelphi, MD 20783-2128 |
Second Address | Bowie, MD 20716-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 18/04/2013 |