| NPI | 1073904322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 993519) |
| Additional Taxonomies | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: NY 993519) |
| 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: NY 993519) | |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2026-02-17 |