| NPI | 1063308823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ROBERT GALLEGOS Executive Director 701-610-0553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208D00000X General Practice | |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-17 |