Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 14943 | MA |
NPI | 1174559587 |
---|---|
Provider Name | Dr. Zhimon Y. Jacobson |
First Address | Boston, MA 02215-1906 |
Second Address | Boston, MA 02215-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 08/07/2007 |