| NPI | 1972056562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: OR 10177915) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: OR 10177915) |
| 133NN1002X Nutritionist Nutrition, Education (Licence: OR 10177915) | |
| Enumeration Date | 2016-07-29 |
| Last Update Date | 2016-07-29 |