| NPI | 1801909056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P0068) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: TX p0068) |
| 171400000X Health & Wellness Coach | |
| 207Q00000X Family Medicine (Licence: WA OP00001670) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2026-03-03 |