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 |