| NPI | 1376498873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86105419) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 010114-01) |
| Enumeration Date | 2026-02-28 |
| Last Update Date | 2026-02-28 |