| NPI | 1255337861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORAE BENSON Manager 701-780-1401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: ND 4231) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2020-08-22 |