Individual
AHMAD FARHAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
31 GORHAM ST, WALTHAM, MA 02453-8603
(781) 392-4611
Mailing address
31 GORHAM ST, WALTHAM, MA 02453-8603
(781) 392-4611
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S66214485
MA
Other
Enumeration date
08/14/2014
Last updated
12/22/2014
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