| NPI | 1407123425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES EDWARD BOSCARDIN President 612-719-0856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MN LP0709) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |