| NPI | 1912548256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 171M00000X Case Manager/Care Coordinator | |
| 251E00000X Home Health | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2025-08-26 |