Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1174027155 |
---|---|
Provider Name | Motolani Mary Ajibose |
First Address | Richmond, TX 77407-6902 |
Second Address | Houston, TX 77082-5545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2018 |
Last Update Date | 22/03/2018 |