| NPI | 1376768853 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GUSTAF THOMPSON Owner 612-807-0388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP4807) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-11-25 |