| NPI | 1649311218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 005189-1) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education (Licence: NY 2061-0015) |
| 133V00000X Dietitian, Registered (Licence: NY 005189-1) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-07-08 |