| NPI | 1306115837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OR 992) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WA 60231565) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2021-12-17 |