| NPI | 1770040073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 374K00000X |
| 101YP2500X Counselor, Professional | |
| 173C00000X Reflexologist | |
| 174H00000X Health Educator | |
| Enumeration Date | 2019-02-23 |
| Last Update Date | 2019-02-23 |