| NPI | 1851712772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1006X Dietitian, Registered, Nutrition, Metabolic (Licence: WA DI00001197) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: WA DI00001197) |
| 133V00000X Dietitian, Registered (Licence: WA DI00001197) | |
| 133N00000X Nutritionist (Licence: WA DI00001197) | |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2016-10-07 |