| 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 |