| NPI | 1780076844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: TX 5020) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 61933) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2015-02-26 |