| NPI | 1871354803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA KHEZRI JACOBSON Physician Owner 508-719-8947 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| Enumeration Date | 2024-01-17 |
| Last Update Date | 2024-06-10 |