Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 7824 | MN |
NPI | 1255930202 |
---|---|
Provider Name | Mr. Gershom Aaron Tam |
First Address | Minneapolis, MN 55404-4518 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2020 |
Last Update Date | 21/10/2020 |