Individual
OKACH KWOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2104 PARK AVE, MINNEAPOLIS, MN 55404-6607
(612) 295-2979
Mailing address
12757 GERMANE AVE APT 202, APPLE VALLEY, MN 55124-9628
(612) 876-1185
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/27/2020
Last updated
11/27/2020
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