Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 098908 | NY |
NPI | 1023238979 |
---|---|
Provider Name | David Richard Graham |
First Address | Elmira, NY 14905-2226 |
Second Address | Elmira, NY 14905-2226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |