| NPI | 1710394259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086X0206X Surgery, Surgical Oncology (Licence: NM MD2023-1311) |
| Additional Taxonomies | 208600000X Surgery (Licence: NM MD2023-1311) |
| 208D00000X General Practice (Licence: MN 59422) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 26225) | |
| 208600000X Surgery (Licence: MN 59422) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2023-10-04 |