| Specialty | Taxonomy Code | |
|---|---|---|
| * | Rural Health | 261QR1300X |
| Diagnostic Radiology | 2085R0202X | |
| Preventive Medicine | 2083C0008X | |
| Public Health, State or Local | 261QP0905X |
* Indicates primary specialty
| NPI Number | 1083471411 |
| Credentials | MD,MS.ABAIM |
| Entity | Individual |
| Enumeration date | 03/04/2024 |
| Last updated | 04/29/2026 - About a month ago |
| Sole proprietor1 | No |
| Identifiers |
|
| 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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