| NPI | 1750825519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: VA 86001944) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: VA 2306602390) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2017-01-25 |