| NPI | 1265594006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: WA 602538317) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WA 602538317) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-08 |