| NPI | 1609451483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 174H00000X Health Educator |
| 156F00000X Technician/Technologist | |
| 171400000X Health & Wellness Coach | |
| 225700000X Massage Therapist (Licence: CA 85430) | |
| Enumeration Date | 2021-03-13 |
| Last Update Date | 2026-04-27 |