| NPI | 1578116786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MAKONDE OGATO Practice Manager 651-354-6602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QG0250X Clinic/Center, Genetics |
| 261QP3300X Clinic/Center, Pain | |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2019-07-17 |