Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 3095 | TX |
Y | 222Z00000X | Podiatrist | 3095 | TX |
NPI | 1013407105 |
---|---|
Provider Name | Mohammad-Asad Buksh Ilahi |
First Address | Irving, TX 75039-3838 |
Second Address | Irving, TX 75039-3838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2018 |
Last Update Date | 20/08/2021 |