| NPI | 1639619703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND8457) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 4252) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2018-07-03 |