Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 266595 | MA |
NPI | 1013155688 |
---|---|
Provider Name | Hormuzdiyar Henry Dasenbrock |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2009 |
Last Update Date | 05/06/2019 |