| NPI | 1104948041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133NN1002X Nutritionist, Nutrition, Education (Licence: NY 0017161) |
| Additional Taxonomies | 136A00000X Dietetic Technician, Registered (Licence: NY 0017161) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2015-10-16 |