| NPI | 1396138871 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS CHARLES PETRIE Nutritionist 518-490-1720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NY 003560) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-03-09 |