| NPI | 1104064138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX 847306) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT06352) |
| Enumeration Date | 2009-01-29 |
| Last Update Date | 2010-06-28 |