| NPI | 1659110369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY PA3527) |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: KY PA3527) |
| Enumeration Date | 2024-05-22 |
| Last Update Date | 2025-06-26 |