Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 63732 | MN |
NPI | 1053650630 |
---|---|
Provider Name | Mr. Clarence O Ojo |
First Address | St. Cloud, MN 56303-2735 |
Second Address | St. Cloud, MN 56303-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2013 |
Last Update Date | 04/12/2018 |