Individual
DANIEL GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1165 MONTGOMERY DR, SANTA ROSA, CA 95405-4801
(707) 525-5352
Mailing address
1615 HILL RD STE B, NOVATO, CA 94947-4338
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
A148628
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
03/24/2015
Last updated
05/26/2020
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