| NPI | 1578214482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: WI 19325410) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: WI 19325410) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2022-01-12 |