Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 961 | MA |
NPI | 1255491437 |
---|---|
Provider Name | Thomas Cottle |
First Address | Brookline, MA 02445 |
Second Address | Brookline, MA 02445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |