| NPI | 1750759072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER PAUL MASSOGLIA President 651-334-1290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: MN 43602) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 2728) |
| 111NS0005X Chiropractor, Sports Physician (Licence: MN 2728) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MN 43602) | |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2016-02-26 |