| NPI | 1902445240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: ID D-799) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: ID 1011693) |
| Enumeration Date | 2020-01-03 |
| Last Update Date | 2020-01-03 |