| NPI | 1104071539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND2293) |
| Additional Taxonomies | 136A00000X Dietetic Technician, Registered (Licence: FL ND2293) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2020-09-30 |