| NPI | 1184228306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: 86108438) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX 86108438) |
| Enumeration Date | 2020-11-29 |
| Last Update Date | 2024-08-26 |