| NPI | 1700182060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 914599) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: 914599) |
| 133NN1002X Nutritionist Nutrition, Education (Licence: 914599) | |
| 133VN1004X Dietitian, Registered Nutrition, Pediatric (Licence: 914599) | |
| 133VN1005X Dietitian, Registered Nutrition, Renal (Licence: 914599) | |
| 133VN1006X Dietitian, Registered Nutrition, Metabolic (Licence: 914599) | |
| Enumeration Date | 2011-02-03 |
| Last Update Date | 2011-02-03 |