| NPI | 1154499309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: TX S24073) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX S24073) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-12-10 |