| NPI | 1073328712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: CA 4236E30E12) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 15895) |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-02-11 |