| NPI | 1629543533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 171400000X Health & Wellness Coach | |
| 225800000X Recreation Therapist | |
| 374K00000X | |
| Enumeration Date | 2018-10-06 |
| Last Update Date | 2024-09-11 |