Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A48124 | CA |
NPI | 1528165958 |
---|---|
Provider Name | Roger Klima |
First Address | Palo Alto, CA 94306 |
Second Address | Palo Alto, CA 94304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |