Improve Your Healthspan with Mitophagy and Urolithin A

Anurag Singh, MD

Thanks, Laura. Pleasure is mine.

Laura Frontiero, FNP-BC

Yeah. Well, I think the pleasure is actually all mine because I am really excited about what you are going to be bringing to this summit and to these talks today. But first, let us introduce you to our audience. You are an internal medicine doctor and immunologist. You are the chief medical officer at Timeline. And that company develops next-generation advanced nutritional skin care products, targeting improvements in mitochondria and cellular health. And they also produce oral products, which we all be talking about some supplements today. You have authored over 40 articles for top science journals. You have been awarded more than 15 patents and you have designed and led over 50 randomized clinical trials. And the work in the world that you have completed is significant much of your research over the past decade has been on a post-biotic molecule called Urolithin A and we are going to talk all about its health benefits today. So, Dr. Singh, we are really going to jump into this. We are going to talk about where Urolithin A comes from, and why it is good for us. You will also help us link the connection with macro autophagy, dysbiosis, and chronic inflammation. All of which these three topics are being talked about at our summit. And you are finally going to unpack for us why our audience should be paying attention to Urolithin A in terms of longevity. Because I know that our audience is really fascinated with extending their life span, internal, and external. They want to look good. They want to feel good. They want to be here on the planet, leaving a legacy for their family and spending time with their loved ones so with all of that, let us jump right in. Okay?

Anurag Singh, MD

Sure.

Laura Frontiero, FNP-BC

Okay. So first off. All right. So let us unpack what this says. Mitochondrial function is what we are all about here. We know mitochondrial function is really important for cellular health and health span. So can you first explain the connection there, mitochondrial function to cellular health and ultimately health span?

Anurag Singh, MD

Yes, sure. The Cellular health is the bioenergetics of cells is an absolute key pillar of an organ and any organ that has a lot of mitochondria such as the skeletal muscle or the heart or the brain is absolutely reliant on energy. So when these organs, when mitochondria are not functioning well your cells are not functioning well, and when your cells are not functioning well, your organ or tissue is not functioning well and as a result, you will have full body dysfunction which means, for example, that the mitochondria and skeletal muscle are not well, then your muscle cells are not getting enough energy supply to power up the muscle cells, which means now you have mobility and fatigue problems and that kind of manifests to the whole body level as issues moving around and in general finishing your daily activities of living. So that is what is in essence cellular health is it is really a key foundation of your good health and health span.

Laura Frontiero, FNP-BC

I always say to my patients that the end-stage problem with mitochondria decline and cellular decline in mitochondrial decline. We have a word for the mitochondrial decline. It is called Alzheimer’s. It is called heart disease. It is called cancer. So I see you nodding your head. Yes. So we are in the right direction there. In terms of mattering for our health span and making sure that we live long healthy lives, it sounds like if we ignore cellular health or mitochondrial function, we are never going to get there. We are not going to reach that goal.

Anurag Singh, MD

You are absolutely correct. I think mitochondrial dysfunction is that key hallmark of a pillar of aging that connects actually all the dots that lead to organ dysfunction. And so you were mentioning Alzheimer’s disease and Parkinson’s disease and even mobility issues such as frailty and sarcopenia. These are all pointing now all the research is pointing to mitochondrial dysfunction and cellular dysfunction in these tissues. So absolutely.

Laura Frontiero, FNP-BC

And I love how you said almost all the research is pointing to that. And this is what makes this summit so relevant in the conversation right now. Because we are bringing the world’s top researchers and leaders together to help people understand and break this down in a way that makes sense for people. Instead of the high academic speak that we tune out and we can not understand. It is a foreign language academic speak. We are making this super simple. So as we talk about we are going to get into Urolithin A in a second. But I think before we do that, what we need to unpack is mitophagy as a foundational process for health. So before we get into Urolithin A, you have to tell us what Mitophagy is and help us understand it so we can get into that discussion.

Anurag Singh, MD

Sure. Yeah. Mitophagy is a very well-conserved anti-aging sort of pathway that is always happening at the background level. It is a form of autophagy. So a lot of folks that, are in your audience may have heard the word autophagy, which is basically taking the cellular waste and clearing it up. Mitophagy is basically an autophagy of the cellular race inside mitochondria. And what happens with aging or age-related processes, in general, is that mitophagy and autophagy in general start declining. And so what you get is basically you think of the trash bin in your house that if it fills up and you are not cleaning it out. Your house is not going to smell very well. And that is exactly what is happening in these tissues in the cells and the mitochondria are not feeling good. So over time and you are in this process of decline that starts early on in the 30s and 40s and accelerates really in the 50s, 60s, and 70s. And what happens is basically now with the increasing amount of mitochondria waste accumulating, a lot of mitochondria cannot produce energy properly. So these processes of cleaning the waste are slowing down and that is what we call mitophagy in general.

Laura Frontiero, FNP-BC

Okay. So now that we know what Mitophagy is and we are here to talk about Urolithin A, so can you explain what it is? Urolithin A. What is this molecule and how was it discovered? I would really like to know that.

Anurag Singh, MD

Sure. So we started almost a decade and a half back with the whole idea to bring sort of the biotech life science approach to nutrition and really understand how certain natural compounds present in our diet could give a health benefit. One of the key fruits we started to deconstruct was the pomegranate. And there had been a lot of studies around pomegranate, basically attributing the high pomegranate consumption was linked to better cognitive ability to better muscle performance. And so when we started deconstructing the pomegranate, we found there were hundreds of compounds. And these are compounds we often call polyphenols. So these are polyphenols such as alleged tannins in the pomegranate. And so these are present in our diets. Pomegranate is a good source of these polyphenols, alleged tannins. Then there are the nuts like walnuts, pecans, and berries. So we started looking into these compounds, and what we realized with the simple experiment we did was that it was not these compounds that were causing the health benefits, but actually, the gut microbiome was actually taking these dietary precursors and causing a transformation and releasing what we now call as a post biotic in the field, another compound called a Urolithin A. This Urolithin A is basically a gut microbiome derived metabolite that is produced when you are eating healthy foods and diet, such as pomegranate and nuts. And this is the molecule that we found to have great effects on mitochondria and mitophagy in general.

Laura Frontiero, FNP-BC

Okay. So our audience. I think we have a pretty savvy audience. So they know that post-biotics are important. Post-biotic is something that your microbiome makes when you break down and ferment prebiotic foods. So what I am hearing you say is that this Urolithin A is made inside your body by your microbiome, but it needs the raw ingredients of pomegranate specifically is where we get this from. And this polyphenol that is inside of pomegranate becomes this amazing post-biotic that helps fuel the intestinal cells, the healthy bacteria. But I am sure there is more to it than that because this is a very special molecule.

Anurag Singh, MD

Yeah. So there are the two key pillars needed to get Urolithin A. You need to be eating right. So you need to be having a good, healthy eating behavior. Eating a lot of fruits and nuts in your diet so that is one, which we know a lot of people are not doing correctly. The second is that you need to have a very healthy and very rich and diverse gut microbiome. And so we have done studies around the world. We have looked at the French, we have looked at the Canadians, we have looked at the Americans, and the percentages vary. But the highest we saw was in French about 30, 40% in the US, and Canadians, we saw only 10 to 20%. Withholding the adult population had the correct gut microbiome to produce Urolithin A. And even if they did, the levels they made were what I call sub-optimal or sub-therapeutic. So they were not enough to give you sort of the direct benefits And so that is how we came up with giving a direct calibrated supplementation with the post-biotic directly.

Laura Frontiero, FNP-BC

So from reading between the lines. What I am hearing is even if you ate pomegranates every day and probably most people are not going to do that. You will have to tell me what the ideal dose of a pomegranate or the ideal serving of a pomegranate is for this. But even if you did it every day, unless your microbiome was robustly healthy, then you are probably not going to derive the benefits.

Anurag Singh, MD

Yeah. So a glass of pure 100% pomegranate juice is about 4 pomegranates peeled and sort of crushed in a blender. So the good parts, the polyphenols, or the alleged tannins are in these white kind of covering around these red beautiful arrows in the fruit. And so when you grind, you need to grind about four to get a glass of juice up to 40 to 50ml. As someone like me, I typically think I eat a very good healthy diet, but my body can not make it. I just do not have the right gut microbiome. So I can drink six glasses of pomegranate juice. My body still will not make enough or not even a trace of Urolithin A. So that is kind of the story. And in people, what we see is you need to drink about six glasses of juice to get the dose we are giving in a nutrition product.

Laura Frontiero, FNP-BC

Right. And then we are dealing with spikes in blood glucose levels and all kinds of problems if we are drinking six glasses of pomegranate juice. So that is a problem too.

Anurag Singh, MD

It is a big problem. I think these glasses like 30 grams of sugar. So there you go.

Laura Frontiero, FNP-BC

Yeah. Okay. So hear us. Everyone listening right now. The answer to Urolithin A in your body is not to go drink six glasses of pomegranate juice per day because you have some other problems that can occur if you spike up your blood sugar levels too high, which is going to be counterproductive to your longevity goals. So can you share with us a little bit more about how we would get Urolithin A and I know that there is some supplement development. Tell us more about this. And I know you have done many studies on this. I would like to dig into all the benefits once we put these post-biotics in our bodies. But since we are talking about how to get it into our body, let us talk about the supplement Urolithin A.

Anurag Singh, MD

Yeah. We have been studying this molecule now for a good ten years and we have published and named it all, any top academic journal nature science has published our extensive body of scientific evidence and clinical evidence in it now. So we have done with a whole range of products now that give you a very targeted dose of Urolithin A. So in our clinical study, we have seen benefits starting to happen on things like improving cellular mitochondrial health already at 500 milligrams of pure Urolithin A dose. And this translates if you get taken longer for about two to four months in terms of improved muscle strength. And then we have done what is called is absorption studies to see how much increased doses will give you better, higher bioavailability or better absorption. And about a gram, about a thousand milligrams is the top dose we see really in all these randomized clinical trials. So now we have a whole range of foods and supplement products of foods with fruit flavored like berry pomegranate flavored, ginger flavored products that give you a daily dose of 500 milligrams that you can put in your daily lifestyle. Smoothie shakes. And then a lot of people prefer to eat pop pills and take soft gels. And so we have a soft gel product and in addition, we can talk about it. We have also have now started developing skin care products that deliver this molecule topically.

Laura Frontiero, FNP-BC

Yeah, I want to know all about this. So I want our audience to understand why this should be a priority in supporting their mitochondrial health. What are all the benefits they are going to get when they bring this in? And then how do they get it?

Anurag Singh, MD

Yeah. Sort of zoom out into what all people probably are doing today to improve mitochondrial health, right? So you can improve mitochondrial health from a sort of scientific thought process through three different ways. One is what we call biogenesis, which means, you create new healthy mitochondria and so are compounds like resveratrol or energy boosters that are known to do that. The second way is to take your existing pool of functioning mitochondria and make them more efficient. And this is where compounds such as Coenzyme Q10 and L-Carnitine come into play. But the very unique molecule, which is Urolithin A is probably the only well-studied, natural, and clinically proven mitophagy activator, which takes the dysfunctional mitochondria and cleans them out, and then becomes the building blocks of the healthy, newer mitochondria. So that is one thing to keep in mind the uniqueness of this sort of way to improve mitochondria. Unless you clean the waste, you really can boost the other functioning mitochondria. And so. Yeah, go ahead.

Laura Frontiero, FNP-BC

So I think that is really critical to pinpoint. If you do not clean out the mitochondrial waste you will not be able to create new mitochondria, more new energy. You will not be able to solve chronic health problems, you will not be able to recover from chronic health problems. Now there are different things we can do to support mitophagy. Taking a polyphenol supplement is one way we can do that. Why would we want to focus on this when there are other ways we can promote mitochondria cleaning?

Anurag Singh, MD

Yeah. So the two best-known interventions out there today that induce mitophagy in a very robust way are regular aerobic exercise or even resistance exercise to a certain extent. And second is calorie restriction or intermittent fasting, both of which have been extremely well documented and studied. But the issue with those interventions really is compliance, right? Right. Complying to think of an older adult with energy issues as a doctor, and you going to put them on the three days per week of exercise training, they are going to do it for a while. After a while, they are going to have certain compliance issues.

Laura Frontiero, FNP-BC

Guilty. I am Guilty. Guilty as charged

Anurag Singh, MD

Well, you are not older, but yes and the calorie restriction is another one. Overweight people who have a lot of mitochondrial dysfunction have similar issues. You put them on a calorie-restriction diet and the compliance rates are worse than 50%. So I think there is a need. So diet and exercise obviously are the two key pillars of health. And I think what I want our consumer and audience to take away is that there is a key third pillar of health which is cellular incursion and  Urolithin A should be a key sort of element to promote that self-help.

Laura Frontiero, FNP-BC

Okay. So I am really glad that we are talking about all of this. Because if I were queen of everything and if I were in control of everything. I would have everyone try out some intermittent fasting, stick with it, and figure out how to do that. Because we know the research is solid. This actually contributes to longevity. I would have people exercising to their ability and building up on that. But since I can not be at every single one of my clients’ households all the time holding their hand and helping them do this and being accountable to themselves and things come up and life happens. Then something like Urolithin A makes this very simple and dare I say like a biohacking, right? It is biohacking to make this easier. Now the term biohacking to me. I have issues with biohacking because it feels like you are cheating. The word hack sounds like you are cheating, but biohacking actually is not cheating. Biohacking is bio-elevating. It is improving your situation. So what I am hearing is this is a really simple way to get this into your body, to get this support for mitophagy without having to rely on your accountability to do that exercise, to do the intermittent fasting all the time.

Anurag Singh, MD

Yeah, extremely well. So to summarize, I think I see it more as bio-optimization.

Laura Frontiero, FNP-BC

Right, exactly. Exactly.

Anurag Singh, MD

Both your health and your house band, which obviously will then improve your lifespan in general. And we started out actually studying 70, 75-year-olds who were running marathons and comparing their sort of muscle and mitochondrial health with 70, 75-year-olds who were very frail and sedentary. And what we saw, we saw like dysfunctional mitochondria and a defect in Mitophagy. And that is one of the first studies that we published in Nature Metabolism because we actually then took those very frail, sedentary, older adults and we gave them four weeks of supplementation with a very targeted dose of 500 or a gram, fewer than ten. And we were able to show in four weeks a similar signature in their muscles that we take chunks of muscle. And that is the muscle biopsies, and we start to look at them under signatures with gene expression, etc. But what we saw was basically an exercise-like signature in these trials. And that long-term, of course, has numerous health benefits.

Laura Frontiero, FNP-BC

Well, so where my mind is going right now is the hamster wheel that people get on who have low energy and they have, you know, their muscle strength has declined, their energy is low. And they just do not have the motivation or the drive or they can not find the, you know, the drive to keep up with an exercise routine. And they find it challenging to fast. This is a really great way for people who have struggled up until now. If you are not a professional athlete or, you know, in really tiptop condition, this is also a way to get you this benefit without having to be on that wheel of giving up, giving up, giving up all the time because it is too hard.

Anurag Singh, MD

Yeah. And that is the most obvious. You know, I am a trialist, so I obviously have to design trials that have the best chance to show an effect. So you start with older adults with energy issues or mobility issues because you know, their mitochondria are not in the best shape or you work this none of the other trials we did was with overweight individuals who are quote-unquote healthy, but, you know, very sedentary lifestyle, BMI for about 28, 29 and if you put them on a sort of a running real kind of experiment or illness on a treadmill, they do not last too long. And we obviously showed effects there. But then, you know, the Holy Grail is and where the whole mitochondria feel is actually moving is even if elite athletes overtraining is inducing mitochondrial dysfunction. If you are a healthy person, if you just get flu or, you know, a covid or whatever, and you are in the hospital for a few days, your muscles are already starting to have struggling issues in your mitochondria are going to be dysfunctional. And so, you know, now are all our researchers now we actually just finished a trial, and elite athletes were put on a three-week overtraining kind of camp setting. And you see that the mitochondria are struggling to cope up, their muscle recovery is struggling to cope up. So we all need support. And that is why I use the word bio-optimization.

Laura Frontiero, FNP-BC

Yes. And that was actually going to be my next question is how would you use your litany with people who are fit and in shape and people who may even be more on the athletic side? Because, you know, our range of audience viewers here is everyone from Chronic Fatigue Syndrome all the way up to elite athletes who are looking to improve their performance. So can you talk about how your Athena can be used in the person who does have good energy, who does have the ability to exercise, and who might also exercise regularly?

Anurag Singh, MD

Yeah. So, you know, we are running these trials and we also getting a lot of real-world feedback and we have done other studies with Giving Your Lives and they might appear as it is trademarked in these settings is helping even augment the benefits of a regular exercise so or even augment the benefits of intermittent fasting. So that is how I see, you know, sort of a double tool in your kit kit box kind of helping you achieve by optimization. And, you know, obviously, somebody struggling with energy issues is the clear target. But what we are seeing now is a lot of people who do sports are adopting or taking in the use of your religion as part of the daily regimen and why they are using it and the feedback that is coming. It is really a muscle recovery. So when muscles are working over time, they get damaged. And so you accumulate a lot of lactate, you accumulate a lot of inflammation, which is all again pointing out we touched upon it or you touched upon the connections, inflammation, and gut dysbiosis. You know, in the end, what this molecule does or what you are seeing it do is that it even lowers or dampens inflammation just because now your mitochondria are in top shape to the kind of are able to your immune cells have a lot of mitochondria at your heart cells have a lot of mitochondria. And so, you know, that is where we are seeing the real-life real-world uses a lot of athletes who are doing bike races or weightlifting or rowing. They are kind of using it as a recovery tool.

Laura Frontiero, FNP-BC

Oh, excellent. Now, I am sure in all your research because you are such a prolific researcher, can you speak into using your life within in terms of supporting people maybe with cancer or chronic neurodegenerative disorders or, you know, multiple sclerosis, Parkinson’s, anything along those lines? Can you tell us what you know about that?

Anurag Singh, MD

Yeah. So we, of course, have not done randomized trials in different all indications. You mentioned most of our trials have been in fatigued older adults or fatigued, overweight or and now we are moving to sort of the to recovery, you know, angle of research. Now, what we have seen or what we have published or what we are now seeing a lot of interest in the field from other top academics who are interested in the mitochondria space. The National Institute of Aging, actually the first one, about four or five years back, to come out with a big paper where they took a look at about 2000 natural compounds that could target reverse neurodegeneration via, of course, improving mitophagy. And you are a legend, actually stood out at the top when they published this paper showing that even neuronal health could be improved by boosting mitophagy with this aging process. There’s another group that at the Buck Institute of Aging, which is really one of the top Centers for Aging, that is actually repeated the same experiment and showed the same data. So we know brain cells have thousands of mitochondria and with aging, these are compromised. 

So we actually they and we are planning to run a big study with a group at Harvard, really looking at early cognitive decline biomarkers and good mental health in that aspect. Back to your question, about cancer, I am a trained immunologist. So I actually think this whole field of immune biology and immune metabolism has ignored the contribution of mitochondrial optimal mitochondrial health to optimal immune health and we have all talked about immune health a lot in these last two, or three years because of obvious reasons linked to COVID and things like that. But one of our collaborators just came out of the very big paper where he showed actually that the key immune cells are these cells that we call these T cells that always remember the signature of the virus, sort of bacteria. You can supercharge these T cells taking that have been exposed to your liver. And so he’s shown that even fighting cancer is improved in these models of colorectal cancer. And another group is showing that actually a post-cancer recovery. So after you have gone through chemo radio on your recovery, know you are cancer free, you basically are coming out of the immune system and you are coming out with fatigue levels the highest. So that is where also you are hallucinating. But these again, these are trials we are running actively right now.

Laura Frontiero, FNP-BC

Wow. I can not wait to see the outcome of the trials. How long do we have to wait?

Anurag Singh, MD

Well, research is two words. I always say re-insert. So you always have to, you know, keep building. You start somewhere. So we show these great effects of your litany on improving muscle performance. And we, of course, have showed on mitochondrial and cellular health. Now we are getting into brain and immune health. And of course, we can talk about the skin health and the visual signs of aging where we think we can by delivering it right to the organ through topical skin. We can really.

Laura Frontiero, FNP-BC

Yeah. Let us go there. So I know now I know you said that I was young and I would have you guess my age, but I am 50 and so something is going right here for me. I think I have some good genetics and a good healthy lifestyle. And one of the most and most prevalent questions that I get from my community and my clients is how do I slow down aging on the outside? I mean, everybody wants to look good and feel good, right? They would love their energy like the outside of them to match the amazing energy they are feeling on the inside after they work through, you know, healing protocols. So what do you have to say about looking good on the outside?

Anurag Singh, MD

Oh, again, it is very relevant. Part of the discussion we are having is there’s a key component, and that is the energetics of your skin cells. And that is, again, boils down to the mitochondrial health of the skin cells. And so we and others have looked at skin cells from different donors, 28 all the way to the seventies. And the older you are and the older you look at the skin cells of the skin biopsies, the signature is really of impaired mitochondrial health. And so the more wrinkles, sort of visual signs of aging are all sort of now the skin aging has two components and what is called is intrinsic aging. So that is where a lot of these processes where collagen breaks down and things like wrinkles start happening. But the second is extrinsic aging. So what with the harm from sort of the UV exposure over our lifespan, the pollutants in the air, you know, environmental pollutants they are having, they are kind of contributing 80% to that visual aging. And this photodamage, along with the intrinsic aging, is really greatly accelerated. And so what we see in our studies now that these are still a the press data, not that we are trying to get this published. And really the talk from the College Journal is that year-olds and can actually have both intrinsic and extrinsic aging via its effects on mitochondria and immune pathways.

Laura Frontiero, FNP-BC

that is incredible. I am so excited. So it is going to battle. What I just heard you say is it is going to battle the 80% of aging that is caused by the environment.

Anurag Singh, MD

You got it. I mean, take retinol, which is right now being used by almost every person for anti-wrinkle effects. Right. And it works on the intrinsic parts of the aging, you know, sort of rebuilding the college pathways. But there’s a lot of controversy and a lot of irritation. If you put retinol in, you go, you know, directly in the sun. It causes a lot of irritation. So it is, you know if you can have a new safe alternative that hits both extremes again and again, it is a game changer.

Laura Frontiero, FNP-BC

Again. Is this product available yet for the skin?

Anurag Singh, MD

Yeah, we just launched it last month and this is a very timely.

Laura Frontiero, FNP-BC

Oh, it is very timely.

Anurag Singh, MD

We have been selling the oral products for about two years and we just launched the topical line prep side.

Laura Frontiero, FNP-BC

Tell us, where can we find it? Where can our audience get a hold of this?

Anurag Singh, MD

Yeah. So the company timeline, you can go to timelinenutrition.com and you can see all the range of products on at rest Explorer, nutrition, the different food products, the dietary supplements, and of course you will see the skincare products on the website. And if folks want to learn more about the signs, they can go to mitopure.com as well to learn more about the science.

Laura Frontiero, FNP-BC

This is incredible. I know that we are going to get a flood of people checking you out. So in the last couple moments that we have here, final thoughts from you. I mean, you have dedicated your life and your career to medicine, to research, to solving chronic health problems that seem like I feel like we have been so stagnant for so long and I feel like we are entering an era of learning new, innovative, cutting edge ways to solve problems. And you are one of those people who are at the forefront of it. And many people will come after you because you paved the way. So in our last moments here, in this vast knowledge that you have in the healing and natural medicine space, and you also come from this Western medicine’s place as well. So you bring this wealth of knowledge. What would you say to our audience in terms of living well and, you know, creating a long life worth living?

Anurag Singh, MD

Yeah, I think I touched upon it. You know, I have a firm belief that there are three key pillars of health. You know, you, of course, you always need to eat, right? And, you know, diet and exercise are the two absolute key pillars of health and longevity. And oftentimes, you know, we get busy in our lives and we can not really do justice to these pillars. You know, I myself am what I call a weekend warrior. I like to run, but I only find the time on a weekend. So what can you do, you know, as a third pillar. And that is where I think a lot of these biohacking or bio-optimization tools come in. And we certainly think the discovery we have made and studied for 15 years and we got ourselves convinced that for 30 years that this whole feel of silicon tradition and how you can boost cellular health as we all age that sick people are in this compound and we talked about it earlier tonight. Thing is a key part of the puzzle and the future looks great because if we can figure out strategies to even optimize. So I think precision nutrition is a big area where you can really figure out and we are even developing now kits that people can hopefully buy in the future that will tell them if their bodies making this molecule or not and then they can, you know, titer and take the altered dose accordingly. So that is how I see that evolution.

Laura Frontiero, FNP-BC

Thank you so much for your words of wisdom and for being here and supporting, you know, this summit and educating our audience. I am really excited to hear feedback on the products. Once people get to train them out, myself included, I’ll be getting that skin product now that it is available.

Anurag Singh, MD

All right. Thanks for having me, Laura.

Laura Frontiero, FNP-BC

Great piece of. Yeah, thank you, Dr. Singh. Take care. Bye now.