Individual
KASSIM MOHAMED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
860 BLUE GENTIAN RD, STE 200, SAINT PAUL, MN 55121-1564
(952) 737-2965
Mailing address
860 BLUE GENTIAN RD, STE 200, SAINT PAUL, MN 55121-1564
(952) 737-2965
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
1084488
MN
172A00000X
Driver
1084488
MN
374700000X
Technician
Primary
1084488
MN
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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