| NPI | 1346819307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSS ELLIOT GUBRUD Md Owner 612-421-3187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2025-10-31 |