| NPI | 1477960060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 67464) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD468504) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2023-05-02 |