| NPI | 1588431423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: FL ND7580) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: FL ND7508) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-03-06 |