| NPI | 1811399025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYJANE MUSHOW Chief Operating Officer 617-608-1575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MA 57991) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |