| NPI | 1508298324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: KS 1792) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2012035391) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2013-08-02 |