| NPI | 1417507963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA DI61005859) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2019-09-17 |
| Last Update Date | 2019-11-25 |