| NPI | 1649452798 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: MA 2654) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: RI 00650) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2011-04-18 |