| NPI | 1073786067 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric |
| 133NN1002X Nutritionist, Nutrition, Education | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2020-03-13 |