NPI | 1497049563 |
---|---|
Former Name | CHRISTOPHER RYAN VILLAVICENCIO-LAZO |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101260032) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 6516) |
Enumeration Date | 2011-06-06 |
Last Update Date | 2016-06-30 |