| NPI | 1023742350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW ROBERT CAMERON Life Coach 651-348-7278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-07-12 |