| NPI | 1942703939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86100714) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC L005371) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2018-03-15 |