| NPI | 1093201105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: LA 2895) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: LA 2895) |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: LA 2895) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-07-02 |