| NPI | 1972860880 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 59198) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: MN 59198) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2020-08-04 |