| NPI | 1992171110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN VERNON NELSON Owner 952-393-6280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MN LP1543) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2015-10-24 |