| NPI | 1003061391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: UT 9586607) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA RD968057) |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2021-01-09 |