| NPI | 1306329990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH BLACK SMITH Authorized Official, Member 980-224-3514 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2019-02-19 |