Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | G63975 | CA |
NPI | 1124230008 |
---|---|
Provider Name | Dr. Robert Laurence Kronisch |
First Address | San Jose, CA 95192-0037 |
Second Address | San Jose, CA 95192-0037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |