| NPI | 1154068567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 174H00000X Health Educator | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-05-17 |