| NPI | 1972380699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: LA 3489) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: LA 86176044) |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-09-25 |