| NPI | 1366160632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: CA A88B329622) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2025-08-29 |