| NPI | 1275354888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 103TE1100X Psychologist Exercise & Sports | |
| 133NN1002X Nutritionist Nutrition, Education | |
| 133VN1201X Dietitian, Registered Nutrition, Obesity and Weight Management | |
| 1710I1003X Military Health Care Provider Independent Duty Medical Technicians | |
| 171400000X | |
| 171M00000X Case Manager/Care Coordinator | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: MD R00360352) | |
| 224Y00000X Clinical Exercise Physiologist | |
| 225XP0019X Occupational Therapist Physical Rehabilitation | |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2024-10-17 |