| NPI | 1548418031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND2019) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: GA LD002190) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2008-09-09 |