| NPI | 1578053658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT84464) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 86059298) |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2023-07-06 |