| NPI | 1104569904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL 10282) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 133VN1005X Dietitian, Registered, Nutrition, Renal | |
| Enumeration Date | 2022-04-19 |
| Last Update Date | 2024-08-29 |