Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003412099 |
---|---|
Provider Name | Idil Mohamed Hirsi |
First Address | Woodbury, MN 55129-2607 |
Second Address | Woodbury, MN 55129-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2020 |
Last Update Date | 07/12/2020 |