Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath |
NPI | 1316143290 |
---|---|
Provider Name | Mr. Jerry Martin Kantor |
First Address | Roslindale, MA 02131-1716 |
Second Address | Wellesley Hills, MA 02481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 08/07/2007 |