| NPI | 1265231971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 171W00000X Contractor |
| 172V00000X Community Health Worker | |
| 174400000X Specialist | |
| 175T00000X Peer Specialist | |
| 174H00000X Health Educator | |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-03-13 |