Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DF11069 | MA |
NPI | 1063809101 |
---|---|
Provider Name | Corneliu Sima |
First Address | Cambridge, MA 02142-1292 |
Second Address | Cambridge, MA 02142-1292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 15/04/2015 |