| NPI | 1568125854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 989269) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CO 989269) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2021-10-14 |