| NPI | 1649477167 |
|---|---|
| Former Name | JAIME WONG-DOMINGUEZ |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101246156) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: VA 0101246156) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2023-11-03 |