| Specialty | Taxonomy Code | |
|---|---|---|
| * | Primary Care | 261QP2300X |
| Family Medicine | 207Q00000X | |
| Public Health, Federal | 261QP0904X |
* Indicates primary specialty
| NPI Number | 1720308570 |
| Credentials | DO (Doctor of Osteopathic) |
| Entity | Individual |
| Enumeration date | 06/03/2010 |
| Last updated | 12/06/2024 - More than a year 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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