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>> Dietitian, Registered >> Dietary & Nutritional Service Providers

Registrant NPI Number: 1700231693

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
Tel: 541-768-5422  Fax: --

Contact information for business:
Tel: --  Fax: --

Registration Information:
NPI: 1700231693
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y133V00000XDietary & Nutritional Service Providers
Dietitian, Registered

Legacy codes, insurance codes and state license numbers:



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