| NPI | 1639473143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: AZ 964240) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: AZ 2011-0505) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2010-12-28 |