| NPI | 1760751861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 133N00000X Nutritionist |
| 224Y00000X Clinical Exercise Physiologist | |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2011-12-19 |