| NPI | 1588842504 |
|---|---|
| Former Name | SHELLY RAYE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171100000X Acupuncturist (Licence: AZ 1060) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 11908) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2021-05-18 |