| NPI | 1023889649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.192166) |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2025-04-24 |