| NPI | 1134682834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 71611) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 71611) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2022-07-19 |