| NPI | 1093433807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MI 86010619) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2022-08-17 |
| Last Update Date | 2022-08-17 |