| NPI | 1871886382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133NN1002X Nutritionist Nutrition, Education |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95003735) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2016-02-04 |