| NPI | 1750888335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOLOMON M GOULD Owner 651-739-5173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-06-26 |