| NPI | 1629599113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 725264) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC 725264) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2022-07-21 |