| NPI | 1174162853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 17327-I) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL HSE25971) |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2026-04-28 |