| 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 |