| NPI | 1205502580 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OR LD-D10209815) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT89050) |
| 133V00000X Dietitian, Registered (Licence: WA DI61023969) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2023-11-06 |