Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | NA | NH |
NPI | 1679089213 |
---|---|
Provider Name | John R Minahan |
First Address | Stratham, NH 03885-6528 |
Second Address | Stratham, NH 03885-6528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |