| NPI | 1538813977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MD DX7085) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: VA 86101216) |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2025-02-26 |