| NPI | 1386221299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: CO 86078639) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2025-07-22 |