| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 133N00000X Nutritionist |
| 133V00000X Dietitian, Registered |
| 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management |
| 2255A2300X Specialist/Technologist, Athletic Trainer |
| 251C00000X Day Training, Developmentally Disabled Services |
| 261QC1800X Clinic/Center, Corporate Health |
| 261QD1600X Clinic/Center, Developmental Disabilities |
| 373H00000X Day Training/Habilitation Specialist |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-03-23 |