| NPI | 1154065886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1002X Internal Medicine, Physician Nutrition Specialist (Licence: OH 34.018274) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2026-01-08 |