| NPI | 1457483646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 20090) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MD DO2126) |
| 133V00000X Dietitian, Registered (Licence: MD N00206) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2015-04-06 |