| NPI | 1477918571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX 2728293) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education (Licence: TX 2728294) |
| Enumeration Date | 2015-12-17 |
| Last Update Date | 2015-12-17 |