Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | M-9357 | ID |
NPI | 1003834987 |
---|---|
Provider Name | Nicolas A Camilo |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 04/03/2011 |