| NPI | 1740516269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: KY 123580) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2021-07-12 |