| NPI | 1912121104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GISBERTE E JOSPEH Nurse Practitioner 617-414-6321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MA 207X00000X) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |