| NPI | 1992385488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: IA 04035) |
| Additional Taxonomies | 133N00000X Nutritionist |
| 224Y00000X Clinical Exercise Physiologist | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2021-04-09 |