Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036126094 | IL |
Y | 2084N0402X | Child Neurologist | Q6138 | TX |
NPI | 1154592921 |
---|---|
Provider Name | Irfan Ali |
First Address | Houston, TX 77030-2608 |
Second Address | Houston, TX 77030-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2008 |
Last Update Date | 20/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036126094 | (05) | IL |