| NPI | 1811519788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86150604) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NE 1739) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2025-08-14 |