Individual
MR. SAMUEL B MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4337 DREW AVE N, ROBBINSDALE, MN 55422
(651) 373-9286
Mailing address
4337 DREW AVE N, ROBBINSDALE, MN 55422-1550
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2403
MN
Other
Enumeration date
11/07/2012
Last updated
11/07/2012
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