Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC806 | HI |
NPI | 1013015411 |
---|---|
Provider Name | Dr. Glenn Thomas Poulain |
First Address | Honolulu, HI 96819 |
Second Address | Honolulu, HI 96819-1942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 21/09/2012 |