Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 4603 | MN |
NPI | 1063580421 |
---|---|
Provider Name | Lee Moua |
First Address | Saint Paul, MN 55103-1983 |
Second Address | Saint Paul, MN 55103-1983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |