NPI | 1649630203 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085P0229X Radiology Pediatric Radiology (Licence: DE C1-0013675) |
Additional Taxonomies | 2085P0229X Radiology Pediatric Radiology (Licence: KY TP968) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-02-25 |
Last Update Date | 2024-02-01 |