Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 1869 | MN |
NPI | 1679560213 |
---|---|
Provider Name | Mr. Matthew A. Raml |
First Address | Saint Cloud, MN 56303-0617 |
Second Address | Alexandria, MN 56308-2515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 08/07/2007 |