| NPI | 1184397226 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics | 
| Additional Taxonomies | 133V00000X Dietitian, Registered | 
| 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management | |
| Enumeration Date | 2021-07-26 | 
| Last Update Date | 2021-07-26 |