| NPI | 1669840344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L004570N) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered Nutrition, Pediatric (Licence: NC L004570) |
| Enumeration Date | 2015-09-11 |
| Last Update Date | 2015-09-11 |