| NPI | 1861220923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 009411-01) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CT 001724) |
| Enumeration Date | 2024-07-22 |
| Last Update Date | 2024-07-22 |