| NPI | 1205264181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2025-03-10 |