| 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 | 2023-04-04 |