| NPI | 1578183620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MD DX5865) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: VA 17913) |
| Enumeration Date | 2020-04-19 |
| Last Update Date | 2025-03-17 |