| NPI | 1346759800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 171M00000X Case Manager/Care Coordinator | |
| 172A00000X Driver | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 4469053) | |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2024-07-30 |