Individual
DEL SAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3819 LAVERNE AVE N, LAKE ELMO, MN 55042-9629
(651) 770-2224
Mailing address
1096 E 260TH ST, NEW PRAGUE, MN 56071-8880
(320) 255-9530
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP0701
MN
Other
Enumeration date
06/16/2008
Last updated
06/16/2008
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