Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1134357478 |
---|---|
Provider Name | Mr. Mohamed Yusuf Bidare |
First Address | Minneapolis, MN 55423-3221 |
Second Address | Minneapolis, MN 55404-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 25/06/2009 |