Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 20874 | OK |
NPI | 1083668826 |
---|---|
Provider Name | Mary H Li |
First Address | Tulsa, OK 74136-1907 |
Second Address | Tulsa, OK 74136-1907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |