| NPI | 1396363131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: MD DX3765) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education (Licence: MD DX3765) |
| 133N00000X Nutritionist (Licence: MD DX3765) | |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2022-07-08 |