Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology |
NPI | 1619471968 |
---|---|
Provider Name | Andrew Moul |
First Address | Detroit, MI 48201-2417 |
Second Address | Detroit, MI 48201-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 21/03/2018 |