| NPI | 1013729631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: PA DN008447) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MD DX7039) |
| Enumeration Date | 2025-01-21 |
| Last Update Date | 2025-01-21 |