| NPI | 1932561149 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MO 2010039072) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: KS 1893) |
| 174N00000X Lactation Consultant, Non-RN (Licence: 11113168) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2016-03-26 |