| NPI | 1225888720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 225100000X Physical Therapist |
| 106S00000X Behavior Technician | |
| 174200000X Meals | |
| Enumeration Date | 2024-03-26 |
| Last Update Date | 2026-07-25 |