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Individual

SHANE GOBLIRSCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
303 CATLIN ST, BUFFALO, MN 55313-1947
(763) 213-7378
Mailing address
11381 53RD ST NE, ALBERTVILLE, MN 55301-3902
(763) 213-7378

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2533
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2533
BOARD OF MEDICAL PRACTICE
MN
Enumeration date
01/08/2016
Last updated
01/08/2016
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