Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 10402 | TX |
NPI | 1346345022 |
---|---|
Provider Name | Robert K Kimberlin |
First Address | Sherman, TX 75092-6634 |
Second Address | Sherman, TX 75092-6634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 06/03/2008 |