| NPI | 1073171534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WAVRA Owner 651-216-6555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2019-05-30 |