Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 2018014208 | MO |
NPI | 1184980716 |
---|---|
Provider Name | Ali Ayman Jamal |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 12/07/2018 |