Individual
LUIS PEDRO GIL AGOSTINHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
313 BROADWAY N, FARGO, ND 58102-4714
(701) 781-0510
Mailing address
313 BROADWAY N, FARGO, ND 58102-4714
(701) 781-0510
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
GIL-70-9863
ND
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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