| NPI | 1811120116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND3645) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: FL ND3645) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2017-05-10 |