| NPI | 1902190887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT81919) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-08-30 |