| NPI | 1508513813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: AR 2800) |
| 133V00000X Dietitian, Registered (Licence: TX 3299) | |
| 133V00000X Dietitian, Registered (Licence: NC L007687) | |
| 133V00000X Dietitian, Registered (Licence: GA LD006832) | |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2025-08-07 |