| NPI | 1912643461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MD 86109473) |
| Additional Taxonomies | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-09 |