Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 39158 | MN |
NPI | 1104364116 |
---|---|
Provider Name | Hadi Mohseni-Bod |
First Address | Minneapolis, MN 55404-4289 |
Second Address | Minneapolis, MN 55404-4289 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2017 |
Last Update Date | 24/02/2017 |