| NPI | 1912426008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1005X Dietitian, Registered, Nutrition, Renal (Licence: PR 2043) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: PR 0243) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2025-04-07 |