| NPI | 1770309379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA 61370767) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA DI61370767) |
| Enumeration Date | 2024-11-27 |
| Last Update Date | 2024-12-27 |