| NPI | 1629888136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OH LD7271) |
| Additional Taxonomies | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: OH LD7271) |
| Enumeration Date | 2025-01-08 |
| Last Update Date | 2025-01-08 |