| NPI | 1508530726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT85741) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: TX DT85741) |
| 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management (Licence: TX DT85741) | |
| 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: TX DT85741) | |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2024-10-22 |