Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | MN |
NPI | 1194969121 |
---|---|
Provider Name | Mr. Joseph Michael Hall |
First Address | St Cloud, MN 56301 |
Second Address | St Cloud, MN 56301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 21/04/2009 |