| NPI | 1104289719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HANI MOHAMED ISSE President 612-227-7172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335G00000X Medical Foods Supplier (Licence: MN A552620000) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |