| NPI | 1710630256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MD 00257-20-A) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2022-02-03 |