| NPI | 1316473382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER OGETTI NYABERE Provider 952-212-0911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MN CNP0956) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-02-13 |