| NPI | 1073904488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1005X Dietitian, Registered, Nutrition, Renal (Licence: IL 164.005998) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: IL 164.005998) |
| Enumeration Date | 2015-02-08 |
| Last Update Date | 2018-03-09 |