| NPI | 1457093916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: DC DI200001255) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MD DX5348) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-04-13 |