| NPI | 1053988477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MO 2022036290) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 4237) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2023-12-28 |