Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502002976 | MI |
NPI | 1003112855 |
---|---|
Provider Name | Mr. Wojciech Ryszard Sikora |
First Address | Milford, MI 48381-1058 |
Second Address | Milford, MI 48381-1058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2011 |
Last Update Date | 26/01/2011 |