| NPI | 1609541481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX 86036550) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT84198) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2023-08-07 |