| NPI | 1245396050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND1277) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 3577) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2024-12-03 |