| NPI | 1467273797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASRO A AHMED Provider/Manager 952-393-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-10-19 |
| Last Update Date | 2024-12-18 |