| NPI | 1497472476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 133N00000X Nutritionist | |
| 171400000X Health & Wellness Coach | |
| 225100000X Physical Therapist | |
| 2251S0007X Physical Therapist, Sports | |
| 225700000X Massage Therapist | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |