| NPI | 1952436784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WA DI00000669) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: WA DI00000669) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2017-04-21 |