| NPI | 1740790146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER LOREN THOMPSON Owner 612-840-4156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301103705) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |