Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD-8638 | HI |
NPI | 1093815813 |
---|---|
Provider Name | Dr. Andrew William Nichols |
First Address | Honolulu, HI 96813-5525 |
Second Address | Honolulu, HI 96822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 08/07/2007 |