| NPI | 1760136105 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BASHAH T GAINES Owner/Operator 321-216-7352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-03-28 |