Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 235304 | MA |
NPI | 1013182500 |
---|---|
Provider Name | Dr. Brian Gary Skotko |
First Address | Boston, MA 02114-2790 |
Second Address | Boston, MA 02114-2790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2008 |
Last Update Date | 29/08/2012 |