| NPI | 1003636143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY RUSSELL Owner 617-505-1520 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2026-03-18 |