# KODY MICHAEL DUCLOS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1033748124
- **Gender:** Man
- **Credential:** RD, LD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 133VN1004X | Pediatric Nutrition Registered Dietitian | 86117056 | ID | Yes |
| 133VN1301X | Oncology Nutrition Registered Dietitian | 86117056 | ID | — |
| 133VN1401X | Pediatric Critical Care Nutrition Registered Dietitian | 86117056 | ID | — |

## Other

- **Enumeration date:** 04/02/2020
- **Last updated:** 04/02/2020