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Dietary & Nutritional Service Providers Nutritionist

Provider NPI: 1902975998

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
225 BROADWAY SUITE 209 METHUEN, MA 01844-3003 US
Tel: 978-688-7100  Fax: --

Business Mailing Address:
Tel: 508-878-2415  Fax: --

NPI Information:
NPI: 1902975998
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N133N00000XDietary & Nutritional Service Providers
Y175F00000XOther Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 175F00000X





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