Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 205963 | MA |
NPI | 1053428482 |
---|---|
Provider Name | Grace H Lo |
First Address | Boston, MA 02111-1526 |
Second Address | Boston, MA 02111-1526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |