Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | PT13499 | CA |
NPI | 1801979349 |
---|---|
Provider Name | Robert Douglas White |
First Address | La Honda, CA 94020-0474 |
Second Address | Palo Alto, CA 94306-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/07/2007 |