Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 57615 | MA |
NPI | 1053551838 |
---|---|
Provider Name | Dr. Jonathan Paull Gertler |
First Address | Weston, MA 02493-1409 |
Second Address | Weston, MA 02493-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2009 |
Last Update Date | 06/03/2009 |