| NPI | 1982617098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 225700000X Massage Therapist (Licence: HI 12983) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-07-15 |