| NPI | 1538541164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085P0229X Radiology, Pediatric Radiology (Licence: KY 55206) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: OH 35.138489) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2024-02-19 |