| NPI | 1114188778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 54786) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: DC MD037346) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 238469) | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2012-11-01 |