Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 4096 | ND |
NPI | 1497842595 |
---|---|
Provider Name | John T Martsolf |
First Address | Grand Forks, ND 58206-6002 |
Second Address | Grand Forks, ND 58202-6094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 08/07/2007 |