| NPI | 1659796381 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 125.080877) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2022-06-16 |