| NPI | 1013286715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L001982) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NC L001982) |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: NC L001982) | |
| Enumeration Date | 2011-12-26 |
| Last Update Date | 2011-12-26 |