| NPI | 1700501152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX 86099454) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT86989) |
| Enumeration Date | 2022-10-07 |
| Last Update Date | 2024-06-13 |