| NPI | 1811363880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: KY BDNDDN00221541) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: KY BDNDDN00221541) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2018-08-11 |