| NPI | 1720644784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224Y00000X Clinical Exercise Physiologist (Licence: SC 11672) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 11672) |
| Enumeration Date | 2019-05-15 |
| Last Update Date | 2023-06-29 |