| NPI | 1083127609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: PR 2034) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PR 2034) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2024-09-20 |