| NPI | 1811656374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: 86150204) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2024-12-05 |