| NPI | 1124678578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: IL 164.007826) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2019029751) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2021-09-15 |