Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DOS - 820 | HI |
NPI | 1609140375 |
---|---|
Provider Name | Dr. Thomas L Shaver |
First Address | Kapaau, HI 96755-1439 |
Second Address | Kapaau, HI 96755-1439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2012 |
Last Update Date | 28/02/2012 |