| NPI | 1316763261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT85729) |
| Additional Taxonomies | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: 86071602) |
| Enumeration Date | 2024-11-25 |
| Last Update Date | 2025-01-09 |