| NPI | 1881925428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS T ANDERSON Owner 270-901-3412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 174400000X Specialist | |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2020-02-19 |