Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 278525 | MA |
NPI | 1154716967 |
---|---|
Provider Name | Theodore Lee |
First Address | Houston, TX 77090-2612 |
Second Address | Boston, MA 02118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 20/09/2021 |