Individual
GEORGE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
581 KAMOKU ST APT 2008, HONOLULU, HI 96826-5210
(808) 383-5189
Mailing address
581 KAMOKU ST APT 2008, HONOLULU, HI 96826-5210
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
Primary
—
—
Other
Enumeration date
07/28/2020
Last updated
07/28/2020
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