| NPI | 1114122371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC 18313) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education (Licence: DC 18313) |
| 207RI0001X Internal Medicine, Clinical & Laboratory Immunology (Licence: DC 18313) | |
| 209800000X Legal Medicine (Licence: DC 18313) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2007-07-08 |