| NPI | 1982599270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: FL ND12296) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NC L008437) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2025-06-09 |