A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | General Practice | 208D00000X |
| Primary Care | 261QP2300X | |
| Psychosomatic Medicine | 2084P0015X | |
| Student in an Organized Health Care Education/Training Program | 390200000X |
* Indicates primary specialty
| NPI Number | 1790277507 |
| Credentials | MD |
| Entity | Individual |
| Enumeration date | 06/06/2018 |
| Last updated | 01/06/2026 - About 5 months ago |
| Sole proprietor1 | No |
| 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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