| NPI | 1609397371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRI LAROSA Office Manager 617-923-8433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 53035) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 71817) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-07-21 |