| NPI | 1790666550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86277927) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 2024007234) |
| 133V00000X Dietitian, Registered (Licence: OH LD.09706) | |
| 133V00000X Dietitian, Registered (Licence: KS 3428) | |
| 133V00000X Dietitian, Registered (Licence: OR LD-D-10262009) | |
| Enumeration Date | 2025-09-09 |
| Last Update Date | 2025-10-23 |