Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | PSY543 | HI |
NPI | 1043293954 |
---|---|
Provider Name | Dr. Michael Allen Kellar |
First Address | Tripler Amc, HI 96859-5000 |
Second Address | Tripler Amc, HI 96859-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
VAD000 | (02) |