Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | LP 5583 | MN |
NPI | 1023358645 |
---|---|
Provider Name | Kory Alexander Holzer |
First Address | Marshall, MN 56258-2010 |
Second Address | Marshall, MN 56258-2010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2013 |
Last Update Date | 19/02/2013 |