| NPI | 1861828212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW STEPHEN VISCITO Proprietor 701-757-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ND 10982) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2014-01-07 |