| NPI | 1013466499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management |
| 174H00000X Health Educator | |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2020-02-20 |