| NPI | 1013351709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 007492-1) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 007492-1) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2013-09-04 |