| NPI | 1174190029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 226300000X Kinesiotherapist | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2021-09-14 |