| NPI | 1174062608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAKOTA BLACK HAWKE Director Of Operations & Finance 469-213-2762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 132700000X Dietary Manager |
| 207K00000X Allergy & Immunology | |
| 207LP2900X Anesthesiology, Pain Medicine | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2017-02-16 |