| NPI | 1134310410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 006461) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 876988) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2018-05-04 |