Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3598 | MN |
NPI | 1205047800 |
---|---|
Provider Name | Dr. Robert Joel Gustafson |
First Address | Rochester, MN 55902-2082 |
Second Address | Rochester, MN 55902-4147 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 14/11/2011 |