Individual
SHANE RUSSELL KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2679 WAI WAI PL STE 301, KIHEI, HI 96753-8350
(808) 575-2953
Mailing address
2679 WAI WAI PL STE 301, KIHEI, HI 96753-8350
(808) 575-2953
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/12/2018
Last updated
06/12/2018
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