| NPI | 1205534021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: AL 3352) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 86254087) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2023-02-21 |