| NPI | 1447795794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL 86089985) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2016-12-22 |
| Last Update Date | 2023-02-28 |