Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 245854 | MA |
NPI | 1093984742 |
---|---|
Provider Name | Kurtus Dafford |
First Address | Boston, MA 02115-6110 |
Second Address | South Weymouth, MA 02190-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2008 |
Last Update Date | 29/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1076449 | (05) | LA |