| NPI | 1336286616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 44812) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL-2162) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: KY TP069) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2019-10-28 |