| NPI | 1679303630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MA 86055431) |
| Additional Taxonomies | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics (Licence: MA 86055431) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2024-08-05 |