| NPI | 1649816083 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MT MED-NUTR-LIC-78826) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2025-10-10 |