| NPI | 1558709154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND7605) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 007759) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2023-07-20 |