| NPI | 1235710997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MA LDN6799) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NH 1394) |
| 133V00000X Dietitian, Registered (Licence: NY 86079525) | |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2024-01-11 |