| NPI | 1477235760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN HAMILTON Chief Executive Officer 651-565-7768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2023-08-04 |