| NPI | 1962870436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JACQUELINE AHEARN Owner 207-344-7115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: NY 48007672) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-09-14 |