Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 57912 | MA |
NPI | 1255367223 |
---|---|
Provider Name | Michael George Muto |
First Address | Brookline, MA 02445-6002 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 16/05/2012 |