| NPI | 1487065660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRACE KIM Vice President/Psychologist 612-345-5194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 251S00000X (Licence: MN LP5726) |
| 251S00000X (Licence: MN LP5724) | |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2021-02-23 |