Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 7006 | MA |
NPI | 1609197870 |
---|---|
Provider Name | Mr. Jason Bettencourt |
First Address | Salem, MA 01970-2524 |
Second Address | Peabody, MA 01960-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2010 |
Last Update Date | 22/06/2010 |