| NPI | 1821372376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 010583) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: WV 598) |
| Enumeration Date | 2011-10-03 |
| Last Update Date | 2024-11-08 |