Individual
DOOSAN PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
240 BEISER BLVD, SUITE 202, DOVER, DE 19904-8208
(302) 734-0300
Mailing address
1300 S FARMVIEW DR, APT N19, DOVER, DE 19904-3374
(801) 472-7769
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
J3-0000634
DE
Other
Enumeration date
10/28/2016
Last updated
10/28/2016
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