| NPI | 1912090390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH ELEANORE PAYNE Owner Director 763-494-9882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 18878) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2020-08-22 |