| NPI | 1861656597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1004X Dietitian, Registered Nutrition, Pediatric (Licence: MO 200400326) |
| Additional Taxonomies | 133VN1004X Dietitian, Registered Nutrition, Pediatric (Licence: KS 1209) |
| Enumeration Date | 2008-07-11 |
| Last Update Date | 2008-07-11 |