| 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 |