| NPI | 1003098658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: FL ME176222) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME176222) |
| 111N00000X Chiropractor (Licence: FL CH9373) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2026-05-14 |