| NPI | 1215564067 |
|---|---|
| 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 | |
| 261QC1800X | |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2020-03-23 |