Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | PT99 | MA |
NPI | 1255807863 |
---|---|
Provider Name | Nerijus Rackauskas |
First Address | Malden, MA 02148-5142 |
Second Address | Boston, MA 02111-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2018 |
Last Update Date | 22/10/2018 |