Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 103TR0400X | OK |
NPI | 1689941809 |
---|---|
Provider Name | Ade A Bajulaiye |
First Address | Oklahoma, OK 73132 |
Second Address | Oklahoma, OK 73132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2011 |
Last Update Date | 17/11/2011 |