Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 19065 | MD |
NPI | 1255781407 |
---|---|
Provider Name | Mr. Rodel Dapul |
First Address | White Marsh, MD 21162-3414 |
Second Address | White Marsh, MD 21162-3414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2016 |
Last Update Date | 20/06/2016 |