| NPI | 1114510807 |
|---|---|
| Former Name | JESSICA GRACE FAVAZZA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NH 1052) |
| Additional Taxonomies | 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management (Licence: NH 1052) |
| Enumeration Date | 2021-02-15 |
| Last Update Date | 2022-12-13 |