| NPI | 1104658442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171400000X Health & Wellness Coach | |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2024-11-08 |