| NPI | 1750788642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: RI MT02066) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2014-11-21 |