Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501006421 | MI |
NPI | 1003192568 |
---|---|
Provider Name | Ashtiaq Khokhar |
First Address | Southfield, MI 48075-2578 |
Second Address | Southfield, MI 48075-2578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2011 |
Last Update Date | 28/10/2011 |