NPI | 1518654839 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: 86054596) |
Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MD DX4678) |
Enumeration Date | 2023-04-18 |
Last Update Date | 2023-04-18 |