| NPI | 1992443865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 32911) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 32911) |
| Enumeration Date | 2022-05-21 |
| Last Update Date | 2022-09-20 |