| NPI | 1326595703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OK 2126) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: OK 2126) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2016-09-02 |