| NPI | 1790103661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL 265860468) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: FL 265860468) |
| 133NN1002X Nutritionist, Nutrition, Education (Licence: FL 265860468) | |
| 174H00000X Health Educator (Licence: FL 2010245) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |