Individual
MASAYA SHIRAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
875 PERIMETER DR, MOSCOW, ID 83844-2401
(208) 885-2182
Mailing address
875 PERIMETER DR, MOSCOW, ID 83844-2401
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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