| NPI | 1245369149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MA 1582) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NH 198) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2024-02-09 |