Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1366884256 |
---|---|
Provider Name | Mr. Talib Hashim Zambezi |
First Address | Lawton, OK 73505-8103 |
Second Address | Lawton, OK 73505-8103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 22/07/2013 |