| NPI | 1104023969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 960912) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric |
| 133VN1005X Dietitian, Registered, Nutrition, Renal | |
| 133VN1006X Dietitian, Registered, Nutrition, Metabolic | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2020-11-03 |