| NPI | 1437787017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301514514) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 30723) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-06-12 |