| NPI | 1538109889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY DRAGER CFO 651-698-2406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 01898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 000713) |
| 363A00000X Physician Assistant (Licence: IA 000713) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-08-15 |