Individual
MR. RICHARD DEAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICAC
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
450
MT
133V00000X
Registered Dietitian
450
MT
171100000X
Acupuncturist
162
MT
Other
Enumeration date
11/29/2006
Last updated
09/11/2025
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