| NPI | 1720446636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L005004) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2015018923) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2026-06-30 |