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Individual

ABDIRISAK ISMAIL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1363 10TH ST NW APT 202, NEW BRIGHTON, MN 55112-6746
(763) 290-4178
Mailing address
1363 10TH ST NW APT 202, NEW BRIGHTON, MN 55112-6746
(763) 290-4178

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary

Other

Enumeration date
02/04/2022
Last updated
02/04/2022
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