Individual
GARY MICHAEL GOLDETSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
515 DELAWARE ST SE, TMD CLINIC, MINNEAPOLIS, MN 55455-0357
(612) 626-6529
Mailing address
515 DELAWARE ST SE, TMD CLINIC, MINNEAPOLIS, MN 55455-0357
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
LPO 508
MN
Other
Enumeration date
09/26/2006
Last updated
08/14/2007
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