| NPI | 1083420301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-24-387241) |
| 174H00000X Health Educator | |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2025-07-20 |