| 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 |