| NPI | 1437938073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN5254504) |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-06-20 |