Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013257732 |
---|---|
Provider Name | Kristen Koba-Burdt |
First Address | Paia, HI 96779-8618 |
Second Address | Paia, HI 96779-8618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2013 |
Last Update Date | 30/10/2015 |