| NPI | 1558669358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L006090) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: SC 638) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: SC 638) | |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2024-02-22 |