| NPI | 1497563597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: GA LD004145) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA LDN7139) |
| 133V00000X Dietitian, Registered (Licence: MD Dx6367) | |
| 133V00000X Dietitian, Registered (Licence: AK 217060) | |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2024-12-20 |