| NPI | 1245877679 |
|---|---|
| Former Name | JORGE LUIS CANDIOTTI HERRERA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA17258) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA061288) |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2024-05-03 |