| NPI | 1821593237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: RI CSW02741) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60845227) |
| 225700000X Massage Therapist (Licence: RI MT02510) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-08-26 |