| NPI | 1790552636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD EDUARDO REPASS Owner 952-417-6773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |