| NPI | 1184779845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: WA NU00000947) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH00009322) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2025-09-11 |