| NPI | 1164789541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1005X Dietitian, Registered, Nutrition, Renal |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2026-07-20 |