NPI | 1477030534 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 133VN1501X Dietitian, Registered Nutrition, Sports Dietetics (Licence: NC 86063647) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CA 86063647) |
Enumeration Date | 2018-07-23 |
Last Update Date | 2024-03-25 |