| NPI | 1407426067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: PA DN006918) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MD DX4994) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2023-09-25 |