| NPI | 1588068522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OR 10179690) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WA DI60506429) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2021-12-27 |