| NPI | 1407748130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2025-07-17 |
| Last Update Date | 2026-01-15 |