| NPI | 1205200383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH GILLES Owner 651-356-0136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: MN 42885) |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2015-11-30 |