Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 959159 | MA |
NPI | 1225390362 |
---|---|
Provider Name | Larry Medolo |
First Address | Methuen, MA 01844-5855 |
Second Address | Methuen, MA 01844-5855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2012 |
Last Update Date | 23/09/2021 |