| NPI | 1700682556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT89788) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NM NDP-2024-0123) |
| Enumeration Date | 2025-02-21 |
| Last Update Date | 2025-02-21 |