| NPI | 1922252048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133N00000X Nutritionist (Licence: NY 003749-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA CQ001369L) |
| 174400000X Specialist (Licence: PA CL022136L) | |
| 175F00000X Naturopath (Licence: DC NAT173) | |
| 175F00000X Naturopath (Licence: NC 200001706104) | |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2010-01-06 |