NPI | 1811593676 |
---|---|
Entity Type | Organization |
Authorized Contact | IRA KEITH ELLIS Medical Director 731-610-6988 |
Organization Subpart ? | No |
Primary Taxonomy | 133VN1201X Dietitian, Registered Nutrition, Obesity and Weight Management |
Enumeration Date | 2020-12-08 |
Last Update Date | 2020-12-08 |