Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 40491 | AZ |
Y | 207R00000X | Internist | 40491 | AZ |
Y | 111NI0900X | Internist | 40491 | AZ |
NPI | 1033370473 |
---|---|
Provider Name | Qais Abu Ali |
First Address | Canton, OH 44718-3628 |
Second Address | Canton, OH 44718-3628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 14/05/2012 |