Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 270332 | MA |
N | 208000000X | Pediatrician | 270332 | MA |
NPI | 1033643606 |
---|---|
Provider Name | Mr. Bradley De Souza |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 07/08/2019 |