Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | G57968 | CA |
NPI | 1164595856 |
---|---|
Provider Name | Gary Dahl |
First Address | Palo Alto, CA 94304-1811 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 02/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G579680 | (05) | CA |
A53356 | (02) | CA |