| NPI | 1679021257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND7352) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: GA LD004640) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2016-09-13 |