| NPI | 1932426681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086X0206X Surgery Surgical Oncology (Licence: MN 56614) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 56614) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2022-08-03 |