| NPI | 1629326772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 006818) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 01008410) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |