| NPI | 1417405119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133NN1002X Nutritionist, Nutrition, Education (Licence: NY 000961-1) |
| Additional Taxonomies | 3747A0650X Technician, Attendant Care Provider (Licence: NY 000961-1) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2016-09-12 |