| NPI | 1477310498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OH LD.7680) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PA DN005651) |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2025-10-06 |