| NPI | 1972129856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133VN1501X Dietitian, Registered, Nutrition, Sports Dietetics |
| Additional Taxonomies | 133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |