Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DF11738 | MA |
NPI | 1114690385 |
---|---|
Provider Name | Seyed Amir Mousavi |
First Address | Boston, MA 02111-1527 |
Second Address | Boston, MA 02111-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |