| NPI | 1114763372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMED A MOHAMED Authorized Agent 952-213-9989 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Enumeration Date | 2024-07-06 |
| Last Update Date | 2024-07-06 |