NPI | 1154794022 |
---|---|
Former Name | JANELLE DERELLA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA DI60678012) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 4016) |
Enumeration Date | 2015-11-02 |
Last Update Date | 2019-12-12 |