| NPI | 1730889833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 171400000X Health & Wellness Coach | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-04-25 |