Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 217623 | NY |
NPI | 1063511772 |
---|---|
Provider Name | Dr. Lars David Thompson |
First Address | Canton, NY 13617-1450 |
Second Address | Canton, NY 13617-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 15/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H19707 | (02) | NY |