| NPI | 1205442472 |
|---|---|
| Former Name | SI'ARA SHALAI WASHINGTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT003870) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 9454) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 1418) | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2020-09-22 |