| NPI | 1689087264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 133NN1002X Nutritionist Nutrition, Education (Licence: CA 133NN1002) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |