| NPI | 1093919185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: DC NAT007) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: CO 14301) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2007-07-08 |