| NPI | 1215300835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: LA 2638) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 1096369) |
| 133V00000X Dietitian, Registered (Licence: TX DT83099) | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-09 |