| NPI | 1497101091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: LA 2767) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: LA 86065516) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2017-08-24 |