| NPI | 1912327644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 61534) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 61534) |
| 208600000X Surgery (Licence: MO 2020021948) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2020-07-15 |