Individual
KETCH COWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
338 STEVENS AVE, PORTLAND, ME 04103-2605
(207) 691-1992
Mailing address
338 STEVENS AVE, PORTLAND, ME 04103-2605
(207) 691-1992
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/30/2021
Last updated
04/30/2021
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