| NPI | 1417537895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: 86132856) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 1251435428) | |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2025-06-02 |