Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 265821 | MA |
NPI | 1114360195 |
---|---|
Provider Name | Ms. Olivia Justine Liff |
First Address | Roslindale, MA 02131 |
Second Address | Roslindale, MA 02131-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2013 |
Last Update Date | 16/05/2017 |