Individual
BENJAMIN SPORES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 BRIARGATE RD APT I28, MANKATO, MN 56001-5039
(425) 280-1612
Mailing address
175 BRIARGATE RD APT I28, MANKATO, MN 56001-5039
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/31/2023
Last updated
10/31/2023
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