Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003416157 |
---|---|
Provider Name | Ibrahim Adan Noor |
First Address | Waite Park, MN 56387-1664 |
Second Address | Waite Park, MN 56387-1664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2020 |
Last Update Date | 28/10/2020 |