| NPI | 1649763764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 74489) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151010819) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2023-09-14 |