Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1532 | IL |
NPI | 1558473579 |
---|---|
Provider Name | Mr. Michael Gary Minor |
First Address | Bowie, MD 20721-7283 |
Second Address | Washington, DC 20422-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1532 | NATIONAL REGISTRATION (01) | IL |