| NPI | 1295742948 | 
|---|---|
| Professional Name | GLENN RONALD WAITE | 
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: ID M-11148)  | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV 8577)  | 
| 207Q00000X Family Medicine (Licence: CA A38237)  | |
| 207Q00000X Family Medicine (Licence: CO 23679)  | |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: CA A38237)  | |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: CO 23679)  | |
| 2081P0004X Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine (Licence: NV 8577)  | |
| Enumeration Date | 2006-08-02 | 
| Last Update Date | 2014-06-25 |