Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 3120 | MA |
NPI | 1376672014 |
---|---|
Provider Name | Dr. Bassam Mawla |
First Address | Springfield, MA 01104-2441 |
Second Address | Springfield, MA 01103-2143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |