| NPI | 1407296288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENT DAVID SMALLWOOD Clinical Licensed Psychologist 612-836-3886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN LP5358) |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2013-06-26 |