| NPI | 1932806130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 207R00000X Internal Medicine (Licence: MO 222042980056) | |
| Enumeration Date | 2023-02-08 |
| Last Update Date | 2023-02-08 |