| NPI | 1073958187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL M VILARDO Practice Administrator 781-769-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MA 58767) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 41096) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2013-05-02 |