| NPI | 1962750026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE PETRA Business Manager 651-738-8561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MN LP1606) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |