| NPI | 1740031988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID CANGI CEO 484-401-2551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174200000X |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 335G00000X Medical Foods Supplier | |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2024-03-27 |