| NPI | 1063285377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 171400000X Health & Wellness Coach | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2023-10-30 |