Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 60565 | MN |
NPI | 1558688366 |
---|---|
Provider Name | Dr. Bryan Nicholas Rolfes |
First Address | Wayzata, MN 55391-2513 |
Second Address | Wayzata, MN 55391-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 12/02/2019 |