| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| 133NN1002X Nutritionist, Nutrition, Education |
| 172V00000X Community Health Worker |
| 225100000X Physical Therapist |
| 2251S0007X Physical Therapist, Sports |
| 225800000X Recreation Therapist |
| 225XE1200X Occupational Therapist, Ergonomics |
| 225XG0600X Occupational Therapist, Gerontology |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-06-09 |