Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1013487479 |
---|---|
Provider Name | Michael Makoto Kalaeula Bopa Lee |
First Address | Honolulu, HI 96813-5267 |
Second Address | Honolulu, HI 96813-5267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 28/11/2018 |