Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003232588 |
---|---|
Provider Name | David Bailey |
First Address | Boston, MA 02131-2632 |
Second Address | Boston, MA 02131-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2014 |
Last Update Date | 09/03/2014 |