| NPI | 1184324899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: CA EA53D153AF) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2026-10-14 |