| NPI | 1235459736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 004145) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: FL ND2904) |
| 133N00000X Nutritionist (Licence: GA LD001594) | |
| 133N00000X Nutritionist (Licence: WI 450 029) | |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2010-06-07 |