| NPI | 1134400476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX 940704) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT80716) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2011-08-31 |