| NPI | 1942774567 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: 86010196) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: CO 86010196) |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2024-07-03 |