| NPI | 1083659569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY M POGORELEC Business Office Manager 763-502-2937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2020-09-23 |