| NPI | 1801312418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK WILLIAM HOUTS Sole Owner 612-808-9375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MN 61077) |
| Additional Taxonomies | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MN 61077) |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: CA A116329) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: AK 7312) | |
| 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: MD D0070374) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MD D0070374) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A116329) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: AK 7312) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2017-08-15 |