| NPI | 1740786177 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 67299) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 67299) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2020-07-15 |