| NPI | 1265151856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86054556) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT85451) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2022-08-25 |