| NPI | 1487179909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 133N00000X Nutritionist |
| 133NN1002X Nutritionist, Nutrition, Education | |
| 171400000X Health & Wellness Coach | |
| 174400000X Specialist | |
| 1744G0900X Specialist, Graphics Designer | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2025-01-17 |