Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003098443 |
---|---|
Provider Name | Mr. Gerwyn Erick Pimentel Dael |
First Address | Ellicott City, MD 21043-3655 |
Second Address | Fort Lauderdale, FL 33309-3440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2007 |
Last Update Date | 28/11/2007 |