| NPI | 1760753834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH7794) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC12686) | |
| Enumeration Date | 2012-01-22 |
| Last Update Date | 2023-10-27 |