Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 038.012519 | IL |
NPI | 1154759579 |
---|---|
Provider Name | Bryan Thomas Howland |
First Address | Pittsfield, IL 62363-2940 |
Second Address | Pittsfield, IL 62363-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2013 |
Last Update Date | 22/10/2013 |