| NPI | 1215699111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L005641) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2022-04-19 |