| NPI | 1336815562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 69372) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: ID 69372) |
| 363L00000X Nurse Practitioner (Licence: ID 69372) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2024-12-20 |