| NPI | 1548862246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Additional Taxonomies | 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2025-03-30 |