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NPI Profile for MARK MOORE in WACONIA, MN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health |
101YM0800X |
| NPI Number | 1548679384 |
|
| Status | Active | |
| Credentials | MA | |
| Entity | Individual | |
| Enumeration date | 08/06/2014 | |
| Last updated | 08/09/2018 - About 8 years ago | |
| Sole proprietor 1 | No | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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MARK MOORE
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MARK MOORE, MA