| NPI | 1174043590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: GA 004899) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 1104928) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2017-06-27 |