| NPI | 1104560374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE MARIE CASLIN Owner/Registered Dietitian 617-308-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2022-04-25 |