| NPI | 1396151890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: AZ MT-17462) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ MT-17462) |
| 175T00000X Peer Specialist (Licence: AZ MT-17462) | |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2018-01-17 |