| NPI | 1407207418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86012528) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MD DX3961) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2016-06-30 |