| NPI | 1417791138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: SC 2973) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC 2018-00205) |
| Enumeration Date | 2024-06-19 |
| Last Update Date | 2025-06-30 |