| NPI | 1316259708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101258324) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 54101) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2020-01-15 |