Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3532 | MA |
NPI | 1073845525 |
---|---|
Provider Name | Dr. Timothy Richard Latham |
First Address | Newton, MA 02460-1302 |
Second Address | Boston, MA 02116-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2010 |
Last Update Date | 28/07/2020 |