NPI | 1275285751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 1427617729) |
Additional Taxonomies | 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management (Licence: MO 134659711) |
174V00000X Clinical Ethicist (Licence: GA 1427617729) | |
Enumeration Date | 2022-01-25 |
Last Update Date | 2023-12-21 |