| NPI | 1447074992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 1241321208) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: MA 1241205986) |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-14 |