| NPI | 1891182259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD61030907) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA ML60559479) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2022-02-10 |