| NPI | 1619516713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY KELLER Director 651-324-0266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2020-01-06 |