| NPI | 1528550480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NV 39402-DI-0) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0011424) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2026-04-08 |