| NPI | 1194916627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C. RANDON Sole Proprietor 508-238-6909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2007-09-10 |