| NPI | 1215173117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: PA DN004083) |
| Additional Taxonomies | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: PA DN004083) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: PA DN004083) | |
| 133VN1005X Dietitian, Registered, Nutrition, Renal (Licence: PA DN004083) | |
| 133N00000X Nutritionist (Licence: PA DN004083) | |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: PA DN004083) | |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2013-08-26 |