| NPI | 1104161991 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: MS LMT 1214) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: LA LA 4325) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |