Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD60107187 | WA |
NPI | 1063568657 |
---|---|
Provider Name | Soren N Carlsen |
First Address | Wailuku, HI 96793-5816 |
Second Address | Wailuku, HI 96793-5816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 25/01/2019 |