Individual
BRENT SKILLICORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1330 WILDER AVE APT 319, HONOLULU, HI 96822-4272
(808) 780-0014
Mailing address
1330 WILDER AVE APT 319, HONOLULU, HI 96822-4272
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-28076
HI
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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