| NPI | 1982150728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOFIYA TSUKERMAN Htcp 763-494-4686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN L 48617-4) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN L 48617-4) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2016-08-31 |