Individual
MICHAEL LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 45TH ST S, FARGO, ND 58104-8970
(701) 356-4384
(701) 356-4383
Mailing address
3401 45TH ST S, FARGO, ND 58104-8970
(701) 356-4384
(701) 356-4383
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-265180
ND
Other
Enumeration date
04/10/2023
Last updated
04/10/2023
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