Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 6842 | MN |
NPI | 1982283115 |
---|---|
Provider Name | Benjamin Eugene Pupo |
First Address | Minnetonka, MN 55305-1772 |
Second Address | Minnetonka, MN 55305-1772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2021 |
Last Update Date | 05/04/2021 |