| NPI | 1780802173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: WV 800471) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OH 800471) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: WV 800471) | |
| 133VN1005X Dietitian, Registered, Nutrition, Renal (Licence: WV 800471) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2025-09-11 |