| NPI | 1720610678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 010753-01) |
| Additional Taxonomies | 133VN1005X Dietitian, Registered, Nutrition, Renal (Licence: NY 010753-01) |
| Enumeration Date | 2020-02-09 |
| Last Update Date | 2023-12-27 |