Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1487910618 |
---|---|
Provider Name | Godwin Onos Izu |
First Address | Oklahoma City, OK 73118-4627 |
Second Address | Oklahoma City, OK 73118-4627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 24/06/2013 |