| NPI | 1588829428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: MN 58560) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 53609) |
| 208600000X Surgery (Licence: MN 107901) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2020-11-09 |