| NPI | 1124206677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN PALATTAO CAO 651-772-1572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 1428) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2025-10-14 |