Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 35.136761 | OH |
N | 2084N0600X | Clinical Neurophysiologist | 35.136761 | OH |
NPI | 1023428919 |
---|---|
Provider Name | Mohammad Khizar Ali |
First Address | Poland, OH 44514-3687 |
Second Address | Poland, OH 44514-3687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2014 |
Last Update Date | 24/06/2019 |