| NPI | 1124478730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L004365) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: GA LD004617) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-05-15 |