| NPI | 1619580776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86058164) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 4758) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |