| NPI | 1104198415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NJ 1015407) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PA 1015407) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2023-11-25 |