| NPI | 1376312074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT SHORE Owner 617-686-7177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery Sports Medicine |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2023-12-22 |
| Last Update Date | 2024-03-19 |