| NPI | 1740982560 |
|---|---|
| Doing Business As | SELF |
| Entity Type | Organization |
| Authorized Contact | BRIAN KEN ISHIDERA Therapist 808-349-4223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2023-03-17 |