| NPI | 1972119873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NC L006231) |
| Additional Taxonomies | 133NN1002X Nutritionist Nutrition, Education (Licence: NC L006231) |
| 133VN1501X Dietitian, Registered Nutrition, Sports Dietetics (Licence: NC L006231) | |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |