Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH 11340 | FL |
NPI | 1356733737 |
---|---|
Provider Name | Hamid Koi Ibrahim |
First Address | Pembroke Pines, FL 33026-3919 |
Second Address | Pembroke Pines, FL 33026-3919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2015 |
Last Update Date | 23/02/2015 |