| NPI | 1154813210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 76927) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 72074) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2024-08-07 |