Individual
KETORUS GOODING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M04953
Contact information
Practice address
9837 BALE CT, OWINGS MILLS, MD 21117-6106
(443) 801-8955
Mailing address
9837 BALE CT, OWINGS MILLS, MD 21117-6106
(443) 801-8955
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M04953
MD
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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