| NPI | 1184952731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 006800) |
| Additional Taxonomies | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: NY 006800) |
| 133VN1005X Dietitian, Registered, Nutrition, Renal (Licence: NY 006800) | |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2009-11-19 |