| NPI | 1083857361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: CA 1055199) |
| Additional Taxonomies | 133NN1002X Nutritionist Nutrition, Education |
| 335G00000X Medical Foods Supplier | |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2016-12-26 |