Individual
MATTHEW SENG THAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1470 GERVAIS AVE, MAPLEWOOD, MN 55109
(651) 230-9093
Mailing address
1470 GERVAIS AVE, MAPLEWOOD, MN 55109-2050
(651) 230-9093
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
D734045708114
MN
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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