| NPI | 1588066336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MN 5829) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: ID D-797) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2026-03-26 |