| NPI | 1265810949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: CO 01000368) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: CO 01000368) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: CO 01000368) | |
| 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: CO 01000368) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2015-05-13 |