Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8354 | MN |
NPI | 1003965047 |
---|---|
Provider Name | Dr. Harry J Larson |
First Address | Albany, MN 56307 |
Second Address | Albany, MN 56307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |