| NPI | 1447792601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NV 86055586) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NV 39022-DI-0) |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2016-11-04 |