Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D11743 | MN |
NPI | 1134230022 |
---|---|
Provider Name | Rajaram Gopalakrishnan |
First Address | Minneapolis, MN 55455-0357 |
Second Address | Minneapolis, MN 55455-0357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |