| NPI | 1710217120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: TX V7554) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00069746) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2025-04-16 |