| NPI | 1679116123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: PR 2127) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PR 1294-2) |
| 133V00000X Dietitian, Registered (Licence: PR 1305-2) | |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2020-01-17 |