| NPI | 1568043230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND10547) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 3458) |
| Enumeration Date | 2021-04-15 |
| Last Update Date | 2021-12-02 |