Individual
SAM WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4510 SALT LAKE BLVD STE D8, HONOLULU, HI 96818-3172
(808) 486-2804
Mailing address
86-222 KAWILI ST, WAIANAE, HI 96792-2935
(808) 387-6319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-25-406416
HI
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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