| NPI | 1982290383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: MN 79287) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 79287) | |
| Enumeration Date | 2020-12-19 |
| Last Update Date | 2025-07-15 |