| NPI | 1659717163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 949600) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NC L002554) |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: NC L002554) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2018-09-10 |