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 |