| NPI | 1063881449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JACKSON Administrative Officer 808-838-6509 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: HI APRN-1831) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |