| NPI | 1811635493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND6279) |
| Additional Taxonomies | 133VN1301X Dietitian, Registered, Nutrition, Oncology (Licence: FL ND6209) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2022-05-24 |