| NPI | 1114974201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LELAND KARL MARTIN Clinical Director 952-595-0562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP3094) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2008-03-27 |