Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD00032373 | WA |
NPI | 1033780721 |
---|---|
Provider Name | Karriem Ali |
First Address | Tenino, WA 98589-1207 |
Second Address | Tacoma, WA 98418-6646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2021 |
Last Update Date | 12/07/2021 |