| NPI | 1629766373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach (Licence: AZ bh8370) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ bh8370) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2023-04-28 |