| NPI | 1558068791 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA DI61408612) | 
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: KY 275943) | 
| 133V00000X Dietitian, Registered (Licence: UT 11870717-4901) | |
| Enumeration Date | 2023-02-08 | 
| Last Update Date | 2025-09-03 |