| NPI | 1003700055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AHMED MUKTAR Owner 651-395-9860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-06-04 |