| NPI | 1780183186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACKENZIE JENNINGS Credentialing Specialist 617-454-4916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101020789) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2019-08-23 |