Individual
MOHAMED GHONIEM IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
607 HIGHWAY 466, SUITE A, LADY LAKE, FL 32159-3792
(352) 787-0669
Mailing address
607 HIGHWAY 466, SUITE A, LADY LAKE, FL 32159-3792
(352) 787-0669
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT 12757
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 12757
PT LIC
FL
Enumeration date
02/11/2008
Last updated
02/11/2008
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