| NPI | 1831768704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARY VANG Member 612-817-7240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-06-23 |