| NPI | 1336826700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: CA 38643) |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2023-07-17 |