| NPI | 1477165496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133N00000X Nutritionist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2021-11-23 |