Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | LP1655 | MN |
NPI | 1689795015 |
---|---|
Provider Name | Dr. Phillip B Haber |
First Address | Minneapolis, MN 55401-2540 |
Second Address | Minneapolis, MN 55401-2540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |