| NPI | 1952185944 |
|---|---|
| Former Name | BENJAMIN LOPEZ |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 001622-) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 001622) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |