| NPI | 1972087583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1004X Dietitian, Registered Nutrition, Pediatric (Licence: MO 2018017540) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: TX DT89964) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2024-07-15 |