| NPI | 1447517933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA DI 60270930) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: ID D-683) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2012-04-20 |