| NPI | 1336796218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA 86059254) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WA DI60689326) |
| Enumeration Date | 2019-08-24 |
| Last Update Date | 2021-03-22 |