NPI age
13 years
Enumerated 2012-06-01
Across 78 active urology providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | O-1041 | IDAHO STATE LICENSE |
| 05 (MI) | 1154682565 |
Part of a multi-provider practice. 2 other active providers share this practice address in NPPES.
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