| NPI | 1811501695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND12408) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA LDN4915) |
| 133V00000X Dietitian, Registered (Licence: UT 13288465-4901) | |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2023-10-10 |