| NPI | 1881034056 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OH LD.7583) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CT 001134) |
| 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: OH 1069423) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2020-01-23 |