| NPI | 1730778028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: AR 2009) |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 133V00000X Dietitian, Registered (Licence: AR 2039) | |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-07-06 |