| NPI | 1356048136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA 61544854) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML61544854) |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2025-06-02 |