| NPI | 1871932996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 851916) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT05195) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-06-21 |