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Individual
MR. JONATHAN WYMORE
Active
Individual
MR. JONATHAN WYMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD, LD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LDD10175002
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86065504
COMMISION ON DIETETIC REGISTRATION
—
01
—
LDD10175002
OREGON DIETETIC LICENSURE
OR
Enumeration date
11/08/2016
Last updated
11/08/2016
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