Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | A154527 | CA |
NPI | 1104280189 |
---|---|
Provider Name | Keiran Warner |
First Address | Boston, MA 02118-2521 |
Second Address | Boston, MA 02118-2521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 11/09/2020 |