| NPI | 1215514039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 31638) |
| 208600000X Surgery (Licence: MN 71933) | |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2026-07-30 |