Individual
DAVID M JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
203 KAPAA QUARRY PL, 5002, KAILUA, HI 96734
(808) 247-2973
Mailing address
1132 BISHOP ST UNIT 1121, HONOLULU, HI 96813-6712
(505) 577-1107
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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