| NPI | 1174174577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OH LD.08307) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: OH LD.08307) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2020-01-07 |