Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003187618 |
---|---|
Provider Name | Anthony Adigwe |
First Address | Edmond, OK 73003-6262 |
Second Address | Edmond, OK 73003-6262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2012 |
Last Update Date | 13/01/2012 |