| NPI | 1548550049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OH LD.7036) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: KY 2277) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2023-05-19 |