| NPI | 1518648161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 23-224) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL HSE38843) |
| 363A00000X Physician Assistant (Licence: PR 002271-P.A.) | |
| Enumeration Date | 2023-07-27 |
| Last Update Date | 2025-01-11 |