Individual
BOLIVAR ERNESTO PANCHI-ARCILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4635 NICOLS RD # 104, EAGAN, MN 55122-3337
(424) 296-0126
Mailing address
4635 NICOLS RD # 104, EAGAN, MN 55122-3337
(424) 296-0126
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/25/2024
Last updated
01/20/2025
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