| NPI | 1598297533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RABIN GERRAH Member 617-671-8448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TX R1029) |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty (Licence: TX R1029) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2017-03-29 |