| NPI | 1366092827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MN 4733) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: GA LD005394) |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2023-06-27 |