| NPI | 1104525112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator (Licence: WA 37796) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: WA 37796) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-02-28 |