Individual
EVAN ROUBAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12054 MISSISSIPPI DR N, CHAMPLIN, MN 55316-2110
(760) 725-5298
Mailing address
12054 MISSISSIPPI DRIVE, CHAMPLIN, MN 55316
(760) 725-5298
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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