| NPI | 1346061694 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 101Y00000X Counselor |
| 133N00000X Nutritionist | |
| 171400000X Health & Wellness Coach | |
| 174H00000X Health Educator | |
| Enumeration Date | 2024-10-21 |
| Last Update Date | 2024-10-21 |