| NPI | 1164696159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MA 1206) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 2091-0221) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2011-12-19 |