Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY848 | HI |
NPI | 1134177785 |
---|---|
Provider Name | Lisa Kaneshiro |
First Address | Hilo, HI 96720-4740 |
Second Address | Pahoa, HI 96778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 08/07/2007 |