| NPI | 1609474998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON STADTHER CEO/Owner 763-515-8799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |