| NPI | 1699181792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3008539) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| 174H00000X Health Educator | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2018-09-26 |