| NPI | 1780474809 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 136A00000X Dietetic Technician, Registered (Licence: 86358698) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2026-04-10 |