| NPI | 1417662321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MN 3008) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 1049416) |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2024-01-29 |