| NPI | 1528735594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 132700000X Dietary Manager |
| 133N00000X Nutritionist | |
| 174H00000X Health Educator | |
| 224Z00000X Occupational Therapy Assistant | |
| 225100000X Physical Therapist | |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| 225700000X Massage Therapist | |
| 225X00000X Occupational Therapist | |
| 226000000X Recreational Therapist Assistant | |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2021-08-26 |