| NPI | 1942066568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK JAMES DAGENDESH Authorized Offical 651-263-1394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2025-02-20 |