| NPI | 1366135030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: CA CE942ECBDF) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2023-05-30 |
| Last Update Date | 2025-08-26 |