| NPI | 1780467456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: TX DT89338) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC L006333) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2025-01-02 |