| NPI | 1134743446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA12640800) |
| Additional Taxonomies | 251300000X Local Education Agency (LEA) |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2025-09-17 |