| NPI | 1821755463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: ND 1259) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MN 4551) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2021-11-18 |