| NPI | 1710530290 |
|---|---|
| Former Name | JASMINE DAKOTA OLD SHOES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG60992605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60992605) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2021-04-05 |