| NPI | 1578674172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MA 727180) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: MA 5) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: MA 727180) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-03-10 |