| NPI | 1073970745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: AK 106431) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: FL ND5355) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2022-07-21 |