| NPI | 1003196700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: A-3139356) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03127510) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2021-04-06 |