| NPI | 1780007534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: PR 1850) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: PR 1069633) |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2015-06-08 |