| NPI | 1285290072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VAMSI DWARAM Manager 651-955-6747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC0700X Psychologist Clinical | |
| 103TC1900X Psychologist Counseling | |
| 103TP2701X Psychologist Group Psychotherapy | |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry | |
| 2084S0012X Psychiatry & Neurology Sleep Medicine | |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2019-05-16 |