Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 2008 | MN |
NPI | 1639117559 |
---|---|
Provider Name | Mr. Leon Boris Frid |
First Address | St Louis Park, MN 55416-4728 |
Second Address | Saint Louis Park, MN 55426-3671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
506527500 | (05) | MN |
T39482 | (02) |