Individual
MR. TAKASHI MITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
717 8TH ST N APT 9, FARGO, ND 58102-4470
(308) 293-7258
Mailing address
717 8TH ST N APT 9, FARGO, ND 58102-4470
(308) 293-7258
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
ND
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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