| NPI | 1801533765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: KY 265354) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OH LD.09188) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-05-12 |