| 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 |