| NPI | 1740736750 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY BORCHARDT Licensed Professional Clinical Coun 763-587-8567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 01028) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |