| NPI | 1326216169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PONVELIL PHILIPOSE PHILIP Owner Director 507-345-5049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP2258) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |