| NPI | 1528558244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN FINCHAM Executive Director 763-545-7545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 122300000X Dentist |
| 213E00000X Podiatrist | |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2018-05-17 |