Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD-6187 | HI |
NPI | 1023118734 |
---|---|
Provider Name | Bradley S. Lau |
First Address | Honolulu, HI 96819-1469 |
Second Address | Honolulu, HI 96819-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 12/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029061-03 | (05) | HI |
A93354 | (02) | HI |