| NPI | 1366867962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: DC DI100000588) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PA DN005093) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2014-02-19 |