Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | G67969 | CA |
NPI | 1376665794 |
---|---|
Provider Name | Brian Hilton Graham |
First Address | La Jolla, CA 92037-6638 |
Second Address | La Jolla, CA 92037-6638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 24/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E90629 | (02) | CA |