| NPI | 1407496219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH WANYAMA Provider 763-377-2069 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2023-12-08 |