| NPI | 1902950546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: MA 1911) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: MA 1911) |
| 175F00000X Naturopath (Licence: OR 1019) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |