Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 251998 | MA |
NPI | 1013270164 |
---|---|
Provider Name | Dr. David Truong |
First Address | Boston, MA 92804 |
Second Address | Boston, MA 02124-5615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 22/06/2012 |