| NPI | 1760808646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332U00000X Home Delivered Meals (Licence: FL 2329281) |
| Additional Taxonomies | 335G00000X Medical Foods Supplier (Licence: FL 2329281) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |