Individual
JACOB PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
133N00000X
Nutritionist
—
—
224Y00000X
Clinical Exercise Physiologist
—
—
Other
Enumeration date
12/19/2011
Last updated
12/19/2011
Update your record
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