Individual
ANDREW H JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2440 KUHIO AVE STE OS1, HONOLULU, HI 96815-3347
(808) 349-3141
Mailing address
2100 DATE ST, HONOLULU, HI 96826-4054
(808) 349-3141
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11932
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11932
STATE LICENSE NUMBER
HI
Enumeration date
04/16/2013
Last updated
04/16/2013
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