| NPI | 1285501411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MN 3820) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WI 3067-29) |
| Enumeration Date | 2025-10-22 |
| Last Update Date | 2025-10-22 |