| NPI | 1518975184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PUNYAMURTULA S KISHORE President 617-738-4640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |