| NPI | 1437561479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 62369) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 62369) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2021-07-09 |