Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 390200000X | MD |
NPI | 1417336017 |
---|---|
Provider Name | Mana Ali |
First Address | Baltimore, MD 21239 |
Second Address | Baltimore, MD 21239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2015 |
Last Update Date | 28/05/2015 |