| NPI | 1487165411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT89725) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NM LD-1133) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2024-03-19 |