| NPI | 1033595855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MD DX3730) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: DC NU100000171) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2018-06-16 |