| NPI | 1255057048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: CA D68D6E0F34) |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2025-10-27 |