| NPI | 1770115610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN NICHOLAS CHRISTENSEN CEO 651-231-2004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2023-12-05 |