| NPI | 1891045076 |
|---|---|
| Other Name | JACKIE ROTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MO 2011016811) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MO 1048325) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2021-03-10 |