| NPI | 1629307764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: KY A-3937636) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3844) |
| Enumeration Date | 2009-12-21 |
| Last Update Date | 2025-11-19 |