| Specialty | Taxonomy Code | |
|---|---|---|
| * | Emergency Medical Services | 207PE0004X |
| Emergency Medicine | 207P00000X | |
| General Practice | 208D00000X | |
| Geriatric Medicine | 207QG0300X | |
| Neuromusculoskeletal Medicine & OMM | 204D00000X |
* Indicates primary specialty
| NPI Number | 1215998737 |
| Credentials | DO (Doctor of Osteopathic) |
| Entity | Individual |
| Enumeration date | 04/01/2006 |
| Last updated | 06/07/2019 - About 7 years ago |
| Sole proprietor1 | Yes |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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