Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | MAT-12462 | HI |
Y | 225700000X | Massage Therapist | MAT-12462 | HI |
NPI | 1457822694 |
---|---|
Provider Name | Mrs. Iris Guoxuan Li |
First Address | Honolulu, HI 96814-4277 |
Second Address | Honolulu, HI 96814-4277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2018 |
Last Update Date | 16/12/2018 |