| NPI | 1427459973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 86007861) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 008437) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2026-03-19 |