| NPI | 1235617507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: VA 0019017773) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: ZZ Pn1) |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: ZZ Pn1) | |
| 174H00000X Health Educator (Licence: IN 813532) | |
| 224Y00000X Clinical Exercise Physiologist (Licence: IN 813532) | |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2020-06-17 |