| NPI | 1801509930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: AZ 86064802) |
| Additional Taxonomies | 174N00000X Lactation Consultant, Non-RN (Licence: AZ L-152783) |
| Enumeration Date | 2023-01-04 |
| Last Update Date | 2023-01-04 |