| NPI | 1457061913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician | |
| 171400000X Health & Wellness Coach | |
| 172V00000X Community Health Worker | |
| 174200000X | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: AZ D06541279) | |
| Enumeration Date | 2022-11-24 |
| Last Update Date | 2022-11-24 |