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Individual
BRADLEY KETNER
Active
Individual
BRADLEY KETNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101262858
VA
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
LL92742
SC
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/07/2016
Last updated
08/14/2024
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