Individual
KHARE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
330 BROOKLINE AVE, BOSTON, MA 02215-5400
(617) 667-7672
Mailing address
29 TRASK AVE, QUINCY, MA 02169-7409
(617) 833-8088
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA4863
MA
Other
Enumeration date
11/11/2013
Last updated
11/11/2013
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