| NPI | 1740299106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM PACE Owner 651-645-3115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-22 |