| NPI | 1598490534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 251K00000X Public Health or Welfare | |
| 251V00000X Voluntary or Charitable | |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2022-07-22 |