| NPI | 1912645474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083S0010X Preventive Medicine Sports Medicine (Licence: CO 62365471) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports |
| 133N00000X Nutritionist | |
| 133VN1501X Dietitian, Registered Nutrition, Sports Dietetics | |
| 133NN1002X Nutritionist Nutrition, Education | |
| 133V00000X Dietitian, Registered | |
| 224Y00000X Clinical Exercise Physiologist | |
| 133VN1006X Dietitian, Registered Nutrition, Metabolic | |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2024-06-07 |