| NPI | 1104462860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86000955) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: DC DI100001198) |
| 133V00000X Dietitian, Registered (Licence: MD DX4743) | |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2022-08-17 |