| NPI | 1720370133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORNELL EUGENE HANSEN President 605-275-6128 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SD 4768) |
| Additional Taxonomies | 202K00000X Phlebology |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2019-11-22 |