| NPI | 1558622159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Y00000X Clinical Exercise Physiologist (Licence: NV 1051942) |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: NV 1064500) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2021-01-06 |