| NPI | 1578422358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS MOKONGU Owner/Authorized Representative 651-212-5375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2026-01-19 |
| Last Update Date | 2026-01-19 |