| NPI | 1770978876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist |
| Additional Taxonomies | 133NN1002X Nutritionist Nutrition, Education |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |