| NPI | 1275022410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC 1534) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: SC 1534) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-10-11 |