| NPI | 1174928121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports |
| 171WH0202X Contractor, Home Modifications | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2014-11-01 |
| Last Update Date | 2014-11-01 |