| NPI | 1104024306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 966674) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NE 840) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2008-03-06 |