| NPI | 1124208210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1006X Dietitian, Registered Nutrition, Metabolic (Licence: MD DX2720) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: MD DX2720) |
| 133NN1002X Nutritionist Nutrition, Education (Licence: MD DX2720) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2007-11-06 |