| NPI | 1134525546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA LYNN KETTLESON Owner/Provider 808-365-5988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 0381075) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: HI 2009004214) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2015-01-05 |