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Individual
MR. VAN DYKE KOFI NOAH
Active
Individual
MR. VAN DYKE KOFI NOAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1083493-1-HCBS
MN
385H00000X
Respite Care
1083493-1-HCBS
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1081688-1-AFC
ADULT FOSTER CARE
MN
Enumeration date
11/28/2016
Last updated
11/28/2016
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