Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 1500 | MA |
NPI | 1306140892 |
---|---|
Provider Name | Michael Vincent Frustaci |
First Address | Manchaug, MA 01526-0417 |
Second Address | Manchaug, MA 01526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2010 |
Last Update Date | 27/12/2010 |