Individual
BENJAMIN RANDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
5747 MEMORIAL GYM UNIVERSITY OF MAINE, ORONO, ME 04469-0001
(207) 581-1088
Mailing address
5747 MEMORIAL GYM UNIVERSITY OF MAINE, ORONO, ME 04469-0001
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
AT509
ME
Other
Enumeration date
12/16/2015
Last updated
12/16/2015
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