| NPI | 1255635165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MA 922651) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: MA 2683) |
| Enumeration Date | 2011-01-06 |
| Last Update Date | 2015-03-10 |