| NPI | 1205454907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA 86112806) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2026-03-28 |