| NPI | 1861865404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 1101790) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: DC DI200001566) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2025-04-22 |