| NPI | 1972295376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171400000X Health & Wellness Coach |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TH0004X Psychologist, Health | |
| 261QC1800X Clinic/Center, Corporate Health | |
| 374K00000X | |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2024-09-03 |