| NPI | 1639564859 |
|---|---|
| Former Name | CARRIE SOUKUP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 68052) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: UT 11734059-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11734059-1205) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2024-03-29 |