Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 300390 | CA |
NPI | 1033789045 |
---|---|
Provider Name | Gregory Charles Moses |
First Address | Menlo Park, CA 94025-6559 |
Second Address | Menlo Park, CA 94025-6559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2021 |
Last Update Date | 30/06/2021 |